Provider Demographics
NPI:1275622599
Name:HIMELSTEIN, BRUCE P (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:P
Last Name:HIMELSTEIN
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 1:3070 S 51ST STREET
Mailing Address - Street 2:SUITE 601
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1661
Mailing Address - Country:US
Mailing Address - Phone:414-447-3470
Mailing Address - Fax:414-447-3471
Practice Address - Street 1:3070 S 51ST STREET
Practice Address - Street 2:SUITE 601
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1661
Practice Address - Country:US
Practice Address - Phone:414-447-3470
Practice Address - Fax:414-447-3471
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI43283208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34078200Medicaid
WI34078200Medicaid
WI738400327Medicare Oscar/Certification