Individual
SHANE BREEZE-BALDAUF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1575 N RIVERCENTER DR, MILWAUKEE, WI 53212
(414) 283-8444
(414) 274-5611
Mailing address
1575 N RIVERCENTER DR, MILWAUKEE, WI 53212-3978
(414) 283-8444
(414) 274-5611
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
68339
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100073230
—
WI
Enumeration date
04/07/2016
Last updated
11/24/2021
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