Healthcare Provider Details

I. General information

NPI: 1265479760
Provider Name (Legal Business Name): MITCHELL H PINCUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W OKLAHOMA AVE
MILWAUKEE WI
53215-4330
US

IV. Provider business mailing address

11516 N PORT WASHINGTON RD STE 202
MEQUON WI
53092-3441
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-6420
  • Fax: 414-649-5309
Mailing address:
  • Phone: 262-241-5040
  • Fax: 262-241-5261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberDR.0056171
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number29163
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: