Provider Demographics
NPI:1639144595
Name:BRENOWITZ, JEROLD BARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROLD
Middle Name:BARRY
Last Name:BRENOWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 N LAKE DR
Mailing Address - Street 2:703
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211
Mailing Address - Country:US
Mailing Address - Phone:414-271-5119
Mailing Address - Fax:414-271-3756
Practice Address - Street 1:2315 N LAKE DR
Practice Address - Street 2:703
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211
Practice Address - Country:US
Practice Address - Phone:414-271-5119
Practice Address - Fax:414-271-3756
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30326200Medicaid
WI30326200Medicaid