Provider Demographics
NPI:1982929410
Name:EWING HAAS, JILLIAN LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:LOUISE
Last Name:EWING HAAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JILLIAN
Other - Middle Name:LOUISE
Other - Last Name:EWING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2315 E MORELAND BLVD
Mailing Address - Street 2:WESTBROOK HEALTH CENTER
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-2939
Mailing Address - Country:US
Mailing Address - Phone:262-532-5700
Mailing Address - Fax:262-532-5701
Practice Address - Street 1:2315 E MORELAND BLVD
Practice Address - Street 2:WESTBROOK HEALTH CENTER
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-2939
Practice Address - Country:US
Practice Address - Phone:262-532-5700
Practice Address - Fax:262-532-5701
Is Sole Proprietor?:No
Enumeration Date:2010-03-27
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI56903207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1982929410Medicaid
WIK400206691Medicare PIN