Provider Demographics
NPI:1952317836
Name:NESS, MARY E (MD)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:E
Last Name:NESS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:HEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2626 N 76TH ST
Mailing Address - Street 2:105
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-1137
Mailing Address - Country:US
Mailing Address - Phone:414-774-7794
Mailing Address - Fax:414-771-7731
Practice Address - Street 1:2626 N 76TH ST
Practice Address - Street 2:105
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-1137
Practice Address - Country:US
Practice Address - Phone:414-774-7794
Practice Address - Fax:414-771-7731
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26012208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30742500Medicaid
D33580Medicare UPIN
WI037T 73-601Medicare ID - Type UnspecifiedMILWAUKEE COUNTY