Provider Demographics
NPI:1235672239
Name:PAUL B DOENIER MD, SC
Entity Type:Organization
Organization Name:PAUL B DOENIER MD, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:DOENIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-446-0955
Mailing Address - Street 1:1111 DELAFIELD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3407
Mailing Address - Country:US
Mailing Address - Phone:262-446-0955
Mailing Address - Fax:262-446-0055
Practice Address - Street 1:1111 DELAFIELD ST STE 300
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3407
Practice Address - Country:US
Practice Address - Phone:262-446-0955
Practice Address - Fax:262-446-0055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-22
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49232207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400354306OtherINDIVIDUAL PTAN
WIK100354297OtherGROUP PTAN
WIK100354297OtherGROUP PTAN