Provider Demographics
NPI:1093748493
Name:BUENCAMINO, ERNESTO ERFE (MD)
Entity Type:Individual
Prefix:MR
First Name:ERNESTO
Middle Name:ERFE
Last Name:BUENCAMINO
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 1:6308 8TH AVE
Mailing Address - Street 2:SUITE 3090
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-5031
Mailing Address - Country:US
Mailing Address - Phone:262-658-1678
Mailing Address - Fax:262-658-2730
Practice Address - Street 1:6308 8TH AVE
Practice Address - Street 2:SUITE 3090
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-5031
Practice Address - Country:US
Practice Address - Phone:262-658-1678
Practice Address - Fax:262-658-2730
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20272207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31102200Medicaid
WI1093748493Medicaid
B51835Medicare UPIN
WI32160Medicare ID - Type Unspecified
WI31102200Medicaid