Healthcare Provider Details

I. General information

NPI: 1114020773
Provider Name (Legal Business Name): BRUCE ANDREW SEMON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/06/2025
Certification Date: 07/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 W BROWN DEER RD STE 200
MILWAUKEE WI
53209-1220
US

IV. Provider business mailing address

3900 W BROWN DEER RD STE 200
MILWAUKEE WI
53209-1220
US

V. Phone/Fax

Practice location:
  • Phone: 414-540-2170
  • Fax: 414-540-2171
Mailing address:
  • Phone: 414-540-2170
  • Fax: 414-540-2171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number27318
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: