Provider Demographics
NPI:1831150788
Name:FERGUSON, ANTHONY ARLO (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:ARLO
Last Name:FERGUSON
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 1:3970 N OAKLAND AVE
Mailing Address - Street 2:#501
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211
Mailing Address - Country:US
Mailing Address - Phone:414-961-0304
Mailing Address - Fax:414-961-2061
Practice Address - Street 1:525 W RIVER WOODS PARKWAY
Practice Address - Street 2:STE 130
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53212
Practice Address - Country:US
Practice Address - Phone:414-961-0304
Practice Address - Fax:414-961-2061
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36926207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32619200Medicaid
H01465Medicare UPIN
WI32619200Medicaid