Healthcare Provider Details

I. General information

NPI: 1659513158
Provider Name (Legal Business Name): MATTHEW WILLIAM BUELOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE DIVISION OF PEDIATRIC CARDIOLOGY
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

9000 W WISCONSIN AVE DIVISION OF PEDIATRIC CARDIOLOGY
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-6457
  • Fax: 414-266-2294
Mailing address:
  • Phone: 414-266-6457
  • Fax: 414-266-2294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number55527
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number55527
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: