Individual
CAMERON BLEGEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1475 W GRAND AVE, PORT WASHINGTON, WI 53074-2074
(262) 268-5100
Mailing address
1475 W GRAND AVE, PORT WASHINGTON, WI 53074-2074
(262) 268-5100
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
73170-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100092840
—
WI
Enumeration date
03/22/2017
Last updated
11/23/2021
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