Individual
MR. JEFFREY MARK BARANEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7901 S 6TH ST, OAK CREEK, WI 53154
(414) 346-8000
(414) 346-8010
Mailing address
7901 S 6TH ST, OAK CREEK, WI 53154-2010
(414) 346-8000
(414) 346-8010
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
510-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1922091446
—
WI
Enumeration date
08/30/2005
Last updated
08/29/2018
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