Provider Demographics
NPI:1407899552
Name:ANNESLEY, WILLIAM H JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
Last Name:ANNESLEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1547 UPPER PKWY S
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-2435
Mailing Address - Country:US
Mailing Address - Phone:414-254-5610
Mailing Address - Fax:414-755-7576
Practice Address - Street 1:1547 UPPER PKWY S
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-2435
Practice Address - Country:US
Practice Address - Phone:414-254-5610
Practice Address - Fax:414-755-7576
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21597208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30454300Medicaid
WI1407899552Medicaid
WI680861128Medicare PIN
WI1407899552Medicaid
WI30454300Medicaid
WI736012341Medicare PIN
01138Medicare ID - Type Unspecified