Organization
BURTON A WAISBREN MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BURTON A. WAISBREN I M.D. (PRESIDENT)
(414) 771-5900
Entity
Organization
Contact information
Practice address
3077 N MAYFAIR RD, STE 100, WAUWATOSA, WI 53222-4305
(414) 771-5900
(414) 771-4908
Mailing address
3077 N MAYFAIR RD, STE 100, WAUWATOSA, WI 53222-4305
(414) 771-5900
(414) 771-4908
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
11016
WI
207RI0200X
Infectious Disease Physician
Primary
11016
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004299533
AETNA
—
01
—
11016
LICENSE NUMBER
WI
01
—
1317540002293
HUMANA
—
01
—
131754002293
HUMANA
—
01
—
2784552
AETNA MEDICARE
—
Enumeration date
06/05/2007
Last updated
04/20/2008
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