Individual
DR. STEPHEN THADDEUS VANBLARCOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10400 W NORTH AVENUE, SUITE 300, MILWAUKEE, WI 53214
(414) 771-7470
(414) 771-7433
Mailing address
1126 S 70TH STREET, SUITE N500, MILWAUKEE, WI 53214
(414) 455-4780
(414) 475-2936
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
28611-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31516400
—
WI
Enumeration date
02/13/2006
Last updated
11/30/2021
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