Individual
MARK S BOSTWICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1777 W GRAND AVENUE, PORT WASHINGTON, WI 53074
(262) 284-3456
(262) 284-4543
Mailing address
3003 W GOOD HOPE ROAD, MILWAUKEE, WI 53209
(414) 352-3100
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
22296
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30397000
—
WI
01
—
P00679658
RR MEDICARE
WI
Enumeration date
07/07/2006
Last updated
11/24/2021
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