Provider Demographics
NPI:1013917962
Name:BERNSTEIN, PAUL S
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2040
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53201-2040
Mailing Address - Country:US
Mailing Address - Phone:414-649-3530
Mailing Address - Fax:414-649-3551
Practice Address - Street 1:2801 W KINNICKINNIC RIVER PKWY
Practice Address - Street 2:840
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3669
Practice Address - Country:US
Practice Address - Phone:414-649-3530
Practice Address - Fax:414-649-3551
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24126207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30383000Medicaid
WI002004130Medicare PIN
WI30383000Medicaid
WI002054475Medicare PIN
WI002046515Medicare PIN
WIB51533Medicare UPIN
WI002040245Medicare PIN