| Charles J. Waisbren Md S.c. | |
|
3077 N Mayfair Rd Suite 100 Wauwatosa WI 53222-4305 | |
| (414) 771-5900 | |
| (414) 771-4908 |
| Full Name | Charles J. Waisbren Md S.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 3077 N Mayfair Rd, Wauwatosa, Wisconsin |
| Authorized Official Name and Position | Charles J Waisbren (PHYSICIAN) |
| Authorized Official Contact | 4147715900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Charles J. Waisbren Md S.c. 3077 N Mayfair Rd Suite 100 Wauwatosa WI 53222-4305 Ph: (414) 771-5900 | Charles J. Waisbren Md S.c. 3077 N Mayfair Rd Suite 100 Wauwatosa WI 53222-4305 Ph: (414) 771-5900 |
| NPI Number | 1447302492 |
|---|---|
| Provider Enumeration Date | 01/18/2007 |
| Last Update Date | 03/07/2023 |
| Medicare PECOS PAC ID | 5496858326 |
|---|---|
| Medicare Enrollment ID | O20070314000512 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447302492 | NPI | - | NPPES |
| 1750481206 | Other | WI | PERSONAL NPI # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 25111 (Wisconsin) | Primary |
| Provider Name | Charles J Waisbren |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750481206 PECOS PAC ID: 9133222060 Enrollment ID: I20070314000505 |
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