Healthcare Provider Details

I. General information

NPI: 1124086236
Provider Name (Legal Business Name): MARTIN LEWIS LOBEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 E WISCONSIN AVE 900
MILWAUKEE WI
53202-4300
US

IV. Provider business mailing address

324 E WISCONSIN AVE 900
MILWAUKEE WI
53202-4300
US

V. Phone/Fax

Practice location:
  • Phone: 414-271-4204
  • Fax: 414-271-0373
Mailing address:
  • Phone: 414-271-4204
  • Fax: 414-271-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number19427
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: