Individual
JOHN FAHEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
13850 W CAPITOL DR, BROOKFIELD, WI 53005-2422
(262) 790-1118
(262) 790-2070
Mailing address
3003 W GOOD HOPE RD, MILWAUKEE, WI 53209-2042
(414) 352-3100
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
24511
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3069900
—
WI
01
—
P00836831
RR MEDICARE
WI
Enumeration date
08/05/2006
Last updated
12/01/2021
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