Provider Demographics
NPI:1114978962
Name:HALVERSON, PAUL B (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:B
Last Name:HALVERSON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DIVISION OF RHEUMATOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-6655
Mailing Address - Fax:414-805-6676
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DIVISION OF RHEUMATOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-6655
Practice Address - Fax:414-805-6676
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2013-01-24
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Provider Licenses
StateLicense IDTaxonomies
WI18941207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
002000119KOtherHUMANA
WI1114978962Medicaid
002000119KOtherHUMANA
B53359Medicare UPIN