Individual
DONALD J BACCUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
17280 W NORTH AVE, SUITE 200, BROOKFIELD, WI 53045-4366
(262) 754-8000
(262) 754-8008
Mailing address
17280 W NORTH AVE, SUITE 200, BROOKFIELD, WI 53045-4366
(262) 754-8000
(262) 754-8008
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
21134
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30313100
—
WI
05
—
32666500
—
WI
Enumeration date
08/31/2005
Last updated
07/09/2007
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