Provider Demographics
NPI:1063862456
Name:BLAU, IRA HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:HOWARD
Last Name:BLAU
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-3100
Mailing Address - Fax:414-259-1145
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-3100
Practice Address - Fax:414-259-1145
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI75836207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology