Provider Demographics
NPI:1821008814
Name:BIAGTAN, JUAN T (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:T
Last Name:BIAGTAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4555 WEST SCHROEDER DRIVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223
Mailing Address - Country:US
Mailing Address - Phone:414-365-3210
Mailing Address - Fax:414-365-3225
Practice Address - Street 1:19475 WEST NORTH AVENUE
Practice Address - Street 2:SUITE 308
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045
Practice Address - Country:US
Practice Address - Phone:262-780-4358
Practice Address - Fax:262-780-4002
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2010-09-03
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Provider Licenses
StateLicense IDTaxonomies
WI24129208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30404900Medicaid