Individual
EZRA TEITELBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9200 W WISCONSIN AVE DEPT OF, MILWAUKEE, WI 53226-3522
(414) 955-7113
(414) 805-8097
Mailing address
9200 W WISCONSIN AVE DEPT OF, MILWAUKEE, WI 53226-3522
(414) 955-7113
(414) 805-8097
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
148293
DC
208600000X
Surgery Physician
Primary
85642
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104052521
—
WI
Enumeration date
06/01/2009
Last updated
04/16/2025
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