Healthcare Provider Details

I. General information

NPI: 1972552701
Provider Name (Legal Business Name): INFECTIOUS DISEASE ASSOCIATES, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W KINNICKINNIC RIVER PKWY SUITE 475
MILWAUKEE WI
53215-3669
US

IV. Provider business mailing address

2801 W KINNICKINNIC RIVER PKWY SUITE 475
MILWAUKEE WI
53215-3669
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-3577
  • Fax: 414-649-3753
Mailing address:
  • Phone: 414-649-3577
  • Fax: 414-649-3753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN P BUGGY
Title or Position: PRESIDENT
Credential: MD
Phone: 414-649-3577