Provider Demographics
NPI:1659470763
Name:YOUNG, JEFFREY STEPHEN (MD)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:STEPHEN
Last Name:YOUNG
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:W180 N8000 TOWN HALL ROAD
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051
Mailing Address - Country:US
Mailing Address - Phone:262-255-2500
Mailing Address - Fax:
Practice Address - Street 1:W180 N8000 TOWN HALL ROAD
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051
Practice Address - Country:US
Practice Address - Phone:262-255-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30522-020207W00000X
WI30522207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI317 946 00Medicaid
WI1659470763Medicaid
WIDA9707Medicare ID - Type UnspecifiedRAILROAD MEDICARE GROUPID
WI5177280001Medicare NSC
WI317 946 00Medicaid
WIP00080507Medicare ID - Type UnspecifiedJEFFREY S YOUNG IND RR
WIF22255Medicare UPIN
WI000267020Medicare ID - Type UnspecifiedDR. JEFFREY S. YOUNG