Provider Demographics
NPI:1306825674
Name:BRUEGGEMAN, ROSEMARIE M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSEMARIE
Middle Name:M
Last Name:BRUEGGEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROSEMARIE
Other - Middle Name:M
Other - Last Name:MENDIVIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2801 W KINNICKINNIC RIVER PKWY
Mailing Address - Street 2:STE 170
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3669
Mailing Address - Country:US
Mailing Address - Phone:414-385-1277
Mailing Address - Fax:414-385-8730
Practice Address - Street 1:2801 W KINNICKINNIC RIVER PKWY
Practice Address - Street 2:STE 170
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215
Practice Address - Country:US
Practice Address - Phone:414-385-1277
Practice Address - Fax:414-385-8730
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44926207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34249800Medicaid
WI34249800Medicaid
WI1427347822Medicare NSC
WI0264580002Medicare NSC
WI1588963508Medicare NSC