Provider Demographics
NPI:1619991205
Name:MAST, ALAN E (MD)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:E
Last Name:MAST
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DEPT OF PATHOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-6966
Mailing Address - Fax:414-805-6980
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DEPT OF PATHOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-6966
Practice Address - Fax:414-805-6980
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI45998207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1619991205Medicaid
H95957Medicare UPIN
WI34423300Medicaid