Provider Demographics
NPI:1962493346
Name:DUBNER, HOWARD N (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:N
Last Name:DUBNER
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 1:3003 W GOOD HOPE RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-2042
Mailing Address - Country:US
Mailing Address - Phone:414-352-3100
Mailing Address - Fax:
Practice Address - Street 1:4655 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53212-1004
Practice Address - Country:US
Practice Address - Phone:414-906-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18149207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30917000Medicaid
WI019940443Medicare PIN
B52531Medicare UPIN
000201300Medicare ID - Type Unspecified
WI462364677Medicare PIN