Provider Demographics
NPI:1659460657
Name:ARNOLD, BRENT WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:WAYNE
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:14440 WESTOVER RD
Mailing Address - Street 2:
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-1633
Mailing Address - Country:US
Mailing Address - Phone:262-785-1265
Mailing Address - Fax:414-447-1070
Practice Address - Street 1:3070 N 51ST ST
Practice Address - Street 2:SUITE 309
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1645
Practice Address - Country:US
Practice Address - Phone:414-447-2674
Practice Address - Fax:414-447-1070
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI301822080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31498500Medicaid
WI31498500Medicaid