Individual
DR. GORDON L MORTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2900 W OKLAHOMA AVE, MILWAUKEE, WI 53215-4330
(414) 649-6000
Mailing address
225 S EXECUTIVE DR, BROOKFIELD, WI 53005-4266
(262) 787-4026
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
26157-020
WI
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
26157-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30723700
—
WI
Enumeration date
11/30/2005
Last updated
11/24/2017
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