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General NPI Number Information
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NPI Number | 1144454927
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Entity Type | Individual
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Provider Name | JACOB M BEHRENS M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/08/2009
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 1045 W GLEN OAKS LN STE 205
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City | MILWAUKEE
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State | WI
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Zip | 53202-5320
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Country | US
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Telephone | 414-909-2343
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Fax |
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Provider Business Mailing Address
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Address Line | 4221 W LE GRANDE BLVD
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City | MEQUON
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State | WI
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Zip | 53092-5220
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Country | US
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Telephone | 920-450-4947
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Fax | 888-866-4665
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 62301
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MC-0001
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 55027-20
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License Number State | WI
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