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NPI Code Detail

MEDICARE: DR. MICHAEL E WIDLANSKY M.D.

MEDICARE: DR. MICHAEL E WIDLANSKY M.D.
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
1207RC0000XCardiovascular Disease Physician50715WI
2207R00000XInternal Medicine Physician212680MA

General Provider Information

NPI Number : 1467568220
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL E WIDLANSKY M.D.
Provider Business Mailing Address
First Line : 9200 WEST WISCONSIN AVENUE
Second Line : 5TH FLOOR, SECTION OF CARDIOLOGY
City : WAUWATOSA
State : WI
Zip : 53226-3522
Country : US
Telephone Number : 414-456-6716
Fax Number : 414-456-6203
Provider Business Practice Location Address
First Line : 9200 WEST WISCONSIN AVENUE
Second Line : 5TH FLOOR, SECTION OF CARDIOLOGY
City : WAUWATOSA
State : WI
Zip : 53226-3522
Country : US
Telephone Number : 414-456-6716
Fax Number : 414-456-6203
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2006
Last Update Date : 08/06/2007

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