Provider Demographics
NPI:1053507624
Name:JAMES M. BURY, MD, LTD.
Entity Type:Organization
Organization Name:JAMES M. BURY, MD, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-843-3064
Mailing Address - Street 1:7137 236TH AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:53168-8975
Mailing Address - Country:US
Mailing Address - Phone:262-843-4422
Mailing Address - Fax:262-843-1166
Practice Address - Street 1:7137 236TH AVE STE 103
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:WI
Practice Address - Zip Code:53168-8975
Practice Address - Country:US
Practice Address - Phone:262-843-4422
Practice Address - Fax:262-843-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21314400Medicaid
WI21314400Medicaid
G13725Medicare UPIN