Provider Demographics
NPI:1265479760
Name:PINCUS, MITCHELL H (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:H
Last Name:PINCUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11516 N PORT WASHINGTON RD
Mailing Address - Street 2:STE 202
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3441
Mailing Address - Country:US
Mailing Address - Phone:262-241-5040
Mailing Address - Fax:262-241-5261
Practice Address - Street 1:2900 W OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4330
Practice Address - Country:US
Practice Address - Phone:414-649-6420
Practice Address - Fax:414-649-5309
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2010-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI291632085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31393200Medicaid
WI001001331Medicare PIN
WIB5572Medicare UPIN