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General NPI Number Information
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NPI Number | 1447302492
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Entity Type | Organization
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Legal Business Name | CHARLES J. WAISBREN MD S.C.
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 3077 N MAYFAIR RD SUITE 100
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City | WAUWATOSA
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State | WI
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Zip | 53222-4305
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Country | US
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Telephone | 414-771-5900
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Fax | 414-771-4908
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Provider Business Mailing Address
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Address Line | 3077 N MAYFAIR RD SUITE 100
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City | WAUWATOSA
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State | WI
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Zip | 53222-4305
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Country | US
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Telephone | 414-771-5900
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Fax | 414-771-4908
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. CHARLES J WAISBREN
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Credential | MD S.C.
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Telephone | 414-771-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25111
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License Number State | WI
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