Boudreau, Jason K.

Boudreau, Jason K. is an individual health care provider with primary practice located at 2311 N Prospect Ave , Milwaukee WI 53211-4445. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Boudreau, Jason K. can be contacted via phone (414) 319-3000.

Contact Information

Primary practice address
2311 N Prospect Ave Milwaukee WI 53211-4445
Phone: (414) 319-3000
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 803-025 Wisconsin

Profile Details

NPI number 1518959378
LBN Legal business name Boudreau, Jason K.
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 18th, 2005
Last updated Jun 7th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1518959378 NPPES
Wisconsin MEDICAID 43231600

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