Individual
U MICHAEL BLASCHKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2727 N MAYFAIR RD., SUITE I, WAUWATOSA, WI 53222-4403
(414) 773-6300
Mailing address
4425 N PORT WASHINGTON RD, ATTN: CSMCP CLINIC CREDENTIALING, GLENDALE, WI 53212-1082
(414) 773-6300
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
24466
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30618200
—
WI
Enumeration date
04/03/2006
Last updated
11/08/2013
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