Individual
DR. MARK GLEN BAKALARS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
725 AMERICAN AVE, WAUKESHA, WI 53188-5031
(262) 928-2400
(262) 928-7621
Mailing address
725 AMERICAN AVE, WAUKESHA, WI 53188-5031
(262) 928-2400
(262) 928-7621
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
40309-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34340500
—
WI
Enumeration date
09/20/2005
Last updated
07/08/2007
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