Individual
BRENT THOMAS BOETTCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9200 W WISCONSIN AVE, DEPT OF ANESTHESIOLOGY, MILWAUKEE, WI 53226-3522
(414) 805-6104
(414) 805-5195
Mailing address
9200 W WISCONSIN AVE, DEPT OF ANESTHESIOLOGY, MILWAUKEE, WI 53226-3522
(414) 805-6104
(414) 805-5195
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
58704
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760781900
—
WI
Enumeration date
03/26/2011
Last updated
07/13/2017
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