Provider Demographics
NPI:1518916477
Name:WETHERBEE, JULE N (MD)
Entity Type:Individual
Prefix:
First Name:JULE
Middle Name:N
Last Name:WETHERBEE
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 1:975 PORT WASHINGTON RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-9201
Mailing Address - Country:US
Mailing Address - Phone:414-247-4667
Mailing Address - Fax:414-247-4455
Practice Address - Street 1:975 PORT WASHINGTON RD
Practice Address - Street 2:SUITE 310
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-9201
Practice Address - Country:US
Practice Address - Phone:414-247-4667
Practice Address - Fax:414-247-4455
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23829207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30662600Medicaid
WI000301494Medicare PIN
WI30662600Medicaid