Healthcare Provider Details

I. General information

NPI: 1215985866
Provider Name (Legal Business Name): MICHAEL J URBAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 04/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W OKLAHOMA AVE
MILWAUKEE WI
53215-4330
US

IV. Provider business mailing address

2900 W OKLAHOMA AVE
MILWAUKEE WI
53215-4330
US

V. Phone/Fax

Practice location:
  • Phone: 262-853-3645
  • Fax: 770-237-1723
Mailing address:
  • Phone: 262-853-3645
  • Fax: 770-237-1723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number38597
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: