Healthcare Provider Details

I. General information

NPI: 1851612659
Provider Name (Legal Business Name): ERIN BISHOP MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 11/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE GYNECOLOGIC ONCOLOGY
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE GYNECOLOGIC ONCOLOGY
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-6600
  • Fax: 414-805-6622
Mailing address:
  • Phone: 414-805-6600
  • Fax: 414-805-6622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number27593
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number60707
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: