Provider Demographics
NPI:1518930288
Name:PARTHUM, PETER (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:PARTHUM
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S63W14899 GARDEN TER
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-8312
Mailing Address - Country:US
Mailing Address - Phone:414-422-1021
Mailing Address - Fax:414-427-7797
Practice Address - Street 1:10691 W PARNELL AVE
Practice Address - Street 2:
Practice Address - City:HALES CORNERS
Practice Address - State:WI
Practice Address - Zip Code:53130-2024
Practice Address - Country:US
Practice Address - Phone:414-427-7787
Practice Address - Fax:414-427-7797
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21198207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31899900Medicaid
WIE-16113Medicare UPIN
WI31899900Medicaid