MEDICARE: DR. M J MISHEFSKE MD

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	2080N0001X	Neonatal-Perinatal Medicine Physician	27738	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477525020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. M J MISHEFSKE MD

Provider Business Mailing Address
First Line	:	3225 E BONNIE DR
Second Line	:
City	:	OAK CREEK
State	:	WI
Zip	:	53154-4107
Country	:	US
Telephone Number	:	414-447-2663
Fax Number	:	414-447-2884

Provider Business Practice Location Address
First Line	:	3070 N 51ST ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-1645
Country	:	US
Telephone Number	:	414-447-2663
Fax Number	:	414-447-2884

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

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	07/08/2007

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