Provider Demographics
NPI:1154301513
Name:WU, BOBBY (MD)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:
Last Name:WU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:17000 W NORTH AVE
Mailing Address - Street 2:STE 107W
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4423
Mailing Address - Country:US
Mailing Address - Phone:262-786-3722
Mailing Address - Fax:262-786-0116
Practice Address - Street 1:17000 W NORTH AVE
Practice Address - Street 2:STE 107W
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4423
Practice Address - Country:US
Practice Address - Phone:262-786-3722
Practice Address - Fax:262-786-0116
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2015-02-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI44979208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WII34155Medicare UPIN