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NPI Code Detail

MEDICARE: DAVID BANDOMIR RN

MEDICARE: DAVID BANDOMIR RN
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
1163W00000XRegistered Nurse143137-30WI

General Provider Information

NPI Number : 1871420711
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID BANDOMIR RN
Provider Business Mailing Address
First Line : 707 SHADY LN
Second Line :
City : OCONOMOWOC
State : WI
Zip : 53066-4174
Country : US
Telephone Number : 414-646-6079
Fax Number :
Provider Business Practice Location Address
First Line : 2900 W OKLAHOMA AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53215-4330
Country : US
Telephone Number : 414-649-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2026
Last Update Date : 05/05/2026

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