Individual
JERRY M BLOOMSTEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1220 DEWEY AVE, BLDG 2, WAUWATOSA, WI 53213-2504
(414) 454-6500
Mailing address
1774 N 84TH ST, WAUWATOSA, WI 53226-2817
(414) 475-7118
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
28817
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31465900
—
WI
Enumeration date
03/16/2007
Last updated
11/23/2021
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