Individual
DR. JEFF WIDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2900 W OKLAHOMA AVE, MILWAUKEE, WI 53215-4330
(414) 649-6572
Mailing address
2900 W OKLAHOMA AVE, MILWAUKEE, WI 53215-4330
(414) 649-6572
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
32166
WI
207RP1001X
Pulmonary Disease Physician
Primary
32166-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
290009089
RAILROAD MEDICARE
WI
05
—
32044500
—
WI
Enumeration date
05/10/2006
Last updated
11/23/2021
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