Individual
CHARLES H TIBER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2350 N LAKE DR, #100, MILWAUKEE, WI 53211-4528
(414) 298-7250
Mailing address
4425 N PORT WASHINGTON RD, ATTN: CLINIC CREDENTIALING, GLENDALE, WI 53212-1082
(414) 319-3000
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
23272
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30347900
—
WI
Enumeration date
11/03/2006
Last updated
06/04/2012
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