Provider Demographics
NPI:1356393292
Name:SOIFER, MORTON (MD)
Entity type:Individual
Prefix:DR
First Name:MORTON
Middle Name:
Last Name:SOIFER
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 1:9466 N BROADMOOR RD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-1309
Mailing Address - Country:US
Mailing Address - Phone:414-352-3016
Mailing Address - Fax:
Practice Address - Street 1:9466 N BROADMOOR RD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:WI
Practice Address - Zip Code:53217-1309
Practice Address - Country:US
Practice Address - Phone:414-352-3016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17421207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
004000215VOtherHUMANA
WI30888500Medicaid
WI30888500Medicaid
B56742Medicare UPIN
WI01906000273592Medicare UPIN