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NPI Code Detail

MEDICARE: DR. KRISTIN D BENCIK BOUDREAU D.O.

MEDICARE: DR. KRISTIN D BENCIK BOUDREAU D.O.
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
1208000000XPediatrics Physician43405WI

Other Identifiers

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

General Provider Information

NPI Number : 1588660195
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KRISTIN D BENCIK BOUDREAU D.O.
Provider Business Mailing Address
First Line : 7950 N PORT WASHINGTON RD
Second Line :
City : MILWAUKEE
State : WI
Zip : 53217-3131
Country : US
Telephone Number : 414-228-0099
Fax Number : 414-540-1065
Provider Business Practice Location Address
First Line : 7950 N PORT WASHINGTON RD
Second Line :
City : FOX POINT
State : WI
Zip : 53217-3131
Country : US
Telephone Number : 414-228-0099
Fax Number : 414-540-0165
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2005
Last Update Date : 09/16/2020

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