Provider Demographics
NPI:1063465797
Name:SANDLOW, JAY I (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:I
Last Name:SANDLOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DEPT OF UROLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-0805
Mailing Address - Fax:414-805-0771
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DEPT OF UROLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-0805
Practice Address - Fax:414-805-0771
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI45676208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
005806261POtherHUMANA
WI1063465797Medicaid
WI053P73601Medicare PIN
005806261POtherHUMANA
WI680860414Medicare PIN