Healthcare Provider Details

I. General information

NPI: 1639436629
Provider Name (Legal Business Name): GEOFFREY BELLINI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W KINNICKINNIC RIVER PKWY STE 575
MILWAUKEE WI
53215-5200
US

IV. Provider business mailing address

2901 W KINNICKINNIC RIVER PKWY DEPT STE 540
MILWAUKEE WI
53215-3677
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-3240
  • Fax: 414-649-3244
Mailing address:
  • Phone: 414-649-3240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number69283-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: