MEDICARE: BENJAMIN N WASSERMAN

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	5539-23	WI

General Provider Information

NPI Number	:	1588275226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN N WASSERMAN

Provider Business Mailing Address
First Line	:	3487 N LAKE DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-2919
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3487 N LAKE DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-2919
Country	:	US
Telephone Number	:	414-610-5663
Fax Number	:

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

Provider Enumeration Date	:	08/16/2020
Last Update Date	:	06/18/2024

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