Individual
CRAIG C PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9000 W WISCONSIN AVE, PEDIATRIC NEPHROLOGY, MILWAUKEE, WI 53226-4874
(414) 337-7702
(414) 337-7105
Mailing address
9000 W WISCONSIN AVE, PEDIATRIC NEPHROLOGY, MILWAUKEE, WI 53226-4874
(414) 337-7702
(414) 337-7105
Taxonomy
Speciality
Code
Description
License number
State
2080P0210X
Pediatric Nephrology Physician
27617
IA
2080P0210X
Pediatric Nephrology Physician
Primary
51603
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0299891
—
IA
05
—
1265413298
—
WI
01
—
29989
WELLMARK BCBS
IA
Enumeration date
11/08/2005
Last updated
09/15/2011
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