Individual
MR. MATTHEW JOSEPH BAUCOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPSGT
Contact information
Practice address
11649 N PORT WASHINGTON RD, STE 109, MEQUON, WI 53092
(262) 241-8022
(262) 241-8047
Mailing address
1580 W PORTVIEW DR, APT #2, PORT WASHINGTON, WI 53074
(262) 894-6833
Taxonomy
Speciality
Code
Description
License number
State
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
Primary
—
—
Other
Enumeration date
10/10/2006
Last updated
07/08/2007
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