Provider Demographics
NPI:1609823806
Name:LAUWASSER, MARVIN EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:EDWARD
Last Name:LAUWASSER
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 1:3070 N 51ST ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1645
Mailing Address - Country:US
Mailing Address - Phone:414-463-4259
Mailing Address - Fax:414-463-2728
Practice Address - Street 1:3070 N 51ST ST
Practice Address - Street 2:SUITE 402
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1645
Practice Address - Country:US
Practice Address - Phone:414-463-4259
Practice Address - Fax:414-463-2728
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18393-020207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30172000Medicaid
B54477Medicare UPIN