Provider Demographics
NPI:1942221601
Name:MANDELBAUM, SHMUEL (MD)
Entity Type:Individual
Prefix:
First Name:SHMUEL
Middle Name:
Last Name:MANDELBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:STUART
Other - Middle Name:PAUL
Other - Last Name:MANDELBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6980 N PORT WASHINGTON RD STE 202
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-3900
Mailing Address - Country:US
Mailing Address - Phone:414-351-7100
Mailing Address - Fax:
Practice Address - Street 1:6980 N PORT WASHINGTON RD STE 202
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53217
Practice Address - Country:US
Practice Address - Phone:414-351-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI547712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry