Healthcare Provider Details

I. General information

NPI: 1861582215
Provider Name (Legal Business Name): MARILYN J SINCABAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 S LAYTON BLVD
MILWAUKEE WI
53215-1924
US

IV. Provider business mailing address

2530 CHANTICLEER CT
BROOKFIELD WI
53045
US

V. Phone/Fax

Practice location:
  • Phone: 414-385-6600
  • Fax:
Mailing address:
  • Phone: 262-780-9642
  • Fax: 262-780-9645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number37168
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: