=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831359801
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ETHAN B. HANDLER MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2008
-----------------------------------------------------
Last Update Date | 06/30/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2885 N MAYFAIR RD
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53222-4404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-938-3838
-----------------------------------------------------
Fax | 888-919-1083
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10001 W INNOVATION DR STE 200
-----------------------------------------------------
City | WAUWATOSA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53226-4851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-771-6780
-----------------------------------------------------
Fax | 414-238-2424
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 112649
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207YX0905X
-----------------------------------------------------
Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
-----------------------------------------------------
License Number | 63081
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | 63081
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------