Provider Demographics
NPI:1023087103
Name:DESHUR, WILLIAM R (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:DESHUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2801 W KK RIVER PKWY
Mailing Address - Street 2:SUITE 330
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3669
Mailing Address - Country:US
Mailing Address - Phone:414-649-3240
Mailing Address - Fax:414-649-3244
Practice Address - Street 1:2801 W KK RIVER PKWY
Practice Address - Street 2:SUITE 330
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3669
Practice Address - Country:US
Practice Address - Phone:414-649-3240
Practice Address - Fax:414-649-3244
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2011-11-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI23018208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30324600Medicaid
WI30324600Medicaid
WIB52403Medicare UPIN