Healthcare Provider Details

I. General information

NPI: 1093294068
Provider Name (Legal Business Name): ANDREW BIDNEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2018
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 N 12TH ST RM 1100
MILWAUKEE WI
53233-1305
US

IV. Provider business mailing address

3239 N DOUSMAN ST
MILWAUKEE WI
53212-2247
US

V. Phone/Fax

Practice location:
  • Phone: 414-219-7776
  • Fax: 414-219-7775
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number13733
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: