Healthcare Provider Details

I. General information

NPI: 1750358115
Provider Name (Legal Business Name): TEDD P CAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W KINNICKINNIC RIVER PKWY STE 1080
MILWAUKEE WI
53215-3689
US

IV. Provider business mailing address

2801 W KINNICKINNIC RIVER PKWY STE 1080
MILWAUKEE WI
53215-3689
US

V. Phone/Fax

Practice location:
  • Phone: 414-908-6615
  • Fax: 414-385-2980
Mailing address:
  • Phone: 414-908-6615
  • Fax: 414-385-2980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number29080-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: