Provider Demographics
NPI:1679541866
Name:MAHONEY, JAMES L (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:MAHONEY
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 1:3111 W RAWSON AVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-9417
Mailing Address - Country:US
Mailing Address - Phone:414-761-3100
Mailing Address - Fax:414-761-3111
Practice Address - Street 1:3111 W RAWSON AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9417
Practice Address - Country:US
Practice Address - Phone:414-761-3100
Practice Address - Fax:414-761-3111
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI25990208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31778100Medicaid
WI31778100Medicaid
WIF27126Medicare UPIN