Individual
MARTIN K. WAKEHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9000 W WISCONSIN AVE, PEDIATRIC CRITICAL CARE, MILWAUKEE, WI 53226-4874
(414) 266-3360
(414) 266-3563
Mailing address
9000 W WISCONSIN AVE, PEDIATRIC CRITICAL CARE, MILWAUKEE, WI 53226-4874
(414) 266-3360
(414) 266-3563
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
036-103836
IL
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
51779
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036103836
—
IL
05
—
1073623260
—
WI
Enumeration date
08/30/2006
Last updated
10/06/2014
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