Healthcare Provider Details

I. General information

NPI: 1912465394
Provider Name (Legal Business Name): ZACHARY WERNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE STE 300
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE STE 300
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-0805
  • Fax: 414-955-0122
Mailing address:
  • Phone: 414-805-0805
  • Fax: 414-955-0122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number83241
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: