Healthcare Provider Details

I. General information

NPI: 1285693648
Provider Name (Legal Business Name): ABE FRANK GOLDBAUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 04/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W OKLAHOMA AVE SUITE 106
MILWAUKEE WI
53215-4330
US

IV. Provider business mailing address

2928 MINOT LN
WAUKESHA WI
53188-4451
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-7710
  • Fax: 414-649-7028
Mailing address:
  • Phone: 262-292-9091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number34054-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: