Individual
DR. JASON SCOTT PRUDOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3201 S 16TH ST STE 2015, MILWAUKEE, WI 53215-4532
(414) 649-3810
(262) 240-0841
Mailing address
GREATER MILWAUKEE CRITICAL CARE AND PULMONARY ASSOCIATE, PO BOX 070520, MILWAUKEE, WI 53207-0520
(414) 649-3810
(262) 240-0841
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
63600-20
WI
207RP1001X
Pulmonary Disease Physician
Primary
63600-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100042547
—
WI
Enumeration date
04/01/2013
Last updated
03/25/2019
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