MEDICARE: DRS. FABRIC, SHAFRIN AND BLOOM,S.C.

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	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1710930862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRS. FABRIC, SHAFRIN AND BLOOM,S.C.

Provider Business Mailing Address
First Line	:	5150 N PORT WASHINGTON RD
Second Line	:	#251
City	:	MILWAUKEE
State	:	WI
Zip	:	53217-5474
Country	:	US
Telephone Number	:	414-332-0606
Fax Number	:	414-967-3604

Provider Business Practice Location Address
First Line	:	5150 N PORT WASHINGTON RD
Second Line	:	#251
City	:	MILWAUKEE
State	:	WI
Zip	:	53217-5474
Country	:	US
Telephone Number	:	414-332-0606
Fax Number	:	414-967-3604

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KENNETH S FABRIC
Credential	:	M.D.
Telephone Number	:	414-332-0606

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	12/15/2008

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