Provider Demographics
NPI:1043207806
Name:BJERREGAARD, WILLIAM JAMES (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAMES
Last Name:BJERREGAARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 DURAND AVE
Mailing Address - Street 2:STE 600
Mailing Address - City:STURTEVANT
Mailing Address - State:WI
Mailing Address - Zip Code:53177-2096
Mailing Address - Country:US
Mailing Address - Phone:262-635-5520
Mailing Address - Fax:262-635-5530
Practice Address - Street 1:1244 WISCONSIN AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-1987
Practice Address - Country:US
Practice Address - Phone:262-635-5520
Practice Address - Fax:262-635-5530
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27927-0202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30780400Medicaid
WI000252430Medicare ID - Type Unspecified
WIC65141Medicare UPIN