Provider Demographics
NPI:1184654725
Name:JORGENSEN, SCOTT A (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:JORGENSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:788 N JEFFERSON ST
Mailing Address - Street 2:SUITE 300/ATTN. KAAREN BUTZEN
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3718
Mailing Address - Country:US
Mailing Address - Phone:414-272-8950
Mailing Address - Fax:414-272-0859
Practice Address - Street 1:13133 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE G18
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097-2419
Practice Address - Country:US
Practice Address - Phone:262-243-5000
Practice Address - Fax:262-243-5317
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2016-11-09
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Provider Licenses
StateLicense IDTaxonomies
WI31133207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1184654725Medicaid
WIK400237129Medicare UPIN