MEDICARE: MADELINE BLIHA CARR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	8533-33	WI
2	363A00000X	Physician Assistant	PA12868	TX

General Provider Information

NPI Number	:	1053965574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE BLIHA CARR

Provider Business Mailing Address
First Line	:	6122 N SANTA MONICA BLVD
Second Line	:
City	:	WHITEFISH BAY
State	:	WI
Zip	:	53217-4355
Country	:	US
Telephone Number	:	574-261-3805
Fax Number	:

Provider Business Practice Location Address
First Line	:	9000 W WISCONSIN AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-4874
Country	:	US
Telephone Number	:	414-266-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2019
Last Update Date	:	01/06/2026

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Directions to “ MADELINE BLIHA CARR ” Practice Location

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