Provider Demographics
NPI:1114087640
Name:GUISE, AMY IRENE (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:IRENE
Last Name:GUISE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DEPARTMENT 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:DEPARTMENT 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:2006-12-12
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
AK7236208800000X
WI50552208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1114087640Medicaid
AKMD0975Medicaid
AKFG0353362OtherDEA
AKK163962Medicare PIN
WI68086 0627Medicare PIN
WI73601 1743Medicare PIN
AK0361450001Medicare NSC