Provider Demographics
NPI:1003990961
Name:GREENBAUM, CLIFFORD D (DPM)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:D
Last Name:GREENBAUM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8003 N PORT WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-2647
Mailing Address - Country:US
Mailing Address - Phone:414-228-6444
Mailing Address - Fax:414-228-7005
Practice Address - Street 1:8003 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53217-2647
Practice Address - Country:US
Practice Address - Phone:414-228-6444
Practice Address - Fax:414-228-7005
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI658025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI658025OtherWISCONSIN STATE LIC.
WI43214600Medicaid
WI43214600Medicaid
WI658025OtherWISCONSIN STATE LIC.
WIU19649Medicare UPIN