Provider Demographics
NPI:1114066628
Name:NEWPORT PROFESSIONALS LTD
Entity Type:Organization
Organization Name:NEWPORT PROFESSIONALS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:E
Authorized Official - Last Name:TAXMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-241-8100
Mailing Address - Street 1:11501 N PORT WASHINGTON RD
Mailing Address - Street 2:G30
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3465
Mailing Address - Country:US
Mailing Address - Phone:262-241-8100
Mailing Address - Fax:262-241-8200
Practice Address - Street 1:11501 N PORT WASHINGTON RD
Practice Address - Street 2:G30
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3465
Practice Address - Country:US
Practice Address - Phone:262-241-8100
Practice Address - Fax:262-241-8200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI262272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty