Provider Demographics
NPI:1336172329
Name:AUSSEM, JOHN W (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:AUSSEM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8901 WEST LINCOLN AVENUE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2477
Mailing Address - Country:US
Mailing Address - Phone:414-328-7950
Mailing Address - Fax:414-328-8505
Practice Address - Street 1:945 N 12 STREET
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53201-1305
Practice Address - Country:US
Practice Address - Phone:414-219-6900
Practice Address - Fax:414-219-7893
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
WI19193207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B51282Medicare UPIN