Healthcare Provider Details

I. General information

NPI: 1932475464
Provider Name (Legal Business Name): ADRIENNE BELASCO KLEMENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADRIENNE N BELASCO

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W NATIONAL AVE
MILWAUKEE WI
53295-0001
US

IV. Provider business mailing address

5000 W NATIONAL AVE
MILWAUKEE WI
53295-0001
US

V. Phone/Fax

Practice location:
  • Phone: 414-384-2000
  • Fax:
Mailing address:
  • Phone: 414-384-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number70291
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberMD462060
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number70291
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: