Individual
BENJAMIN VICKERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3237 S 16TH ST, MILWAUKEE, WI 53215-4526
(414) 647-5000
Mailing address
3237 S 16TH ST, MILWAUKEE, WI 53215-4526
(414) 647-5000
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
75942
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/24/2020
Last updated
08/26/2024
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