Provider Demographics
NPI:1477525020
Name:MISHEFSKE, M J (MD)
Entity Type:Individual
Prefix:DR
First Name:M
Middle Name:J
Last Name:MISHEFSKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 E BONNIE DR
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-4107
Mailing Address - Country:US
Mailing Address - Phone:414-447-2663
Mailing Address - Fax:414-447-2884
Practice Address - Street 1:3070 N 51ST ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1645
Practice Address - Country:US
Practice Address - Phone:414-447-2663
Practice Address - Fax:414-447-2884
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI277382080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31795900Medicaid
WIF88150Medicare UPIN
WI31795900Medicaid