Provider Demographics
NPI:1710939319
Name:WALBERGH, ERIC J (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:J
Last Name:WALBERGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC ANESTHESIOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-3560
Mailing Address - Fax:414-266-6092
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC ANESTHESIOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-3560
Practice Address - Fax:414-266-6092
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI28113207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30749100Medicaid
002000328YOtherHUMANA
WI1710939319Medicaid
WI30749100Medicaid
E42785Medicare UPIN