Healthcare Provider Details

I. General information

NPI: 1780791889
Provider Name (Legal Business Name): RUSSELL G TEMME MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 DEWEY AVE
WAUWATOSA WI
53213
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 414-454-6777
  • Fax: 414-454-6656
Mailing address:
  • Phone: 414-454-6753
  • Fax: 414-454-6789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number38195
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: