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General NPI Number Information
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NPI Number | 1497285811
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Entity Type | Individual
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Provider Name | CONSTANTIN NAUTNAY JAEN MD
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Gender | Male
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Dates
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Enumeration Date | 06/18/2017
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 2301 N LAKE DR
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City | MILWAUKEE
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State | WI
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Zip | 53211-4508
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Country | US
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Telephone | 414-585-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 3175 LILLY RD UNIT 107
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City | BROOKFIELD
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State | WI
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Zip | 53005-7602
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Country | US
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Telephone |
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 74896-20
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License Number State | WI
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