Individual
STALEY A BROD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9200 W WISCONSIN AVE, DEPARTMENT OF NEUROLOGY, MILWAUKEE, WI 53226-3522
(414) 805-5200
(414) 259-0469
Mailing address
9200 W WISCONSIN AVE, DEPARTMENT OF NEUROLOGY, MILWAUKEE, WI 53226-3522
(414) 805-5200
(414) 259-0469
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
65374
WI
2084N0400X
Neurology Physician
J0923
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129380505
—
TX
05
—
1740217322
—
WI
01
—
87X552
BCBS
TX
Enumeration date
06/27/2006
Last updated
04/21/2016
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