Provider Demographics
NPI:1528191723
Name:BADINE, EDGARD ATEF (MD)
Entity Type:Individual
Prefix:
First Name:EDGARD
Middle Name:ATEF
Last Name:BADINE
Suffix:
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:PO BOX 8003
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54912-8003
Mailing Address - Country:US
Mailing Address - Phone:920-830-5900
Mailing Address - Fax:920-738-5787
Practice Address - Street 1:1818 N MEADE ST
Practice Address - Street 2:SUITE W120
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-3454
Practice Address - Country:US
Practice Address - Phone:920-735-7300
Practice Address - Fax:920-735-7333
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD 2007-0020207RH0003X
WI64179207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000Z2565OtherMEDICAID GROUP
NM56388071Medicaid
NM800521089OtherMEDICARE GROUP NUMBER
NM1932187044OtherGROUP NPI
NM800521089OtherMEDICARE GROUP NUMBER
NM342717402Medicare PIN
NM000Z2565OtherMEDICAID GROUP