Basic Information
| Provider Information | |||||||||
| NPI: | 1124163407 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAR-LEV | ||||||||
| FirstName: | AVI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 E GRANT ST | ||||||||
| Address2: | |||||||||
| City: | APPLETON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549113487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9207491171 | ||||||||
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| Practice Location | |||||||||
| Address1: | 900 E GRANT ST | ||||||||
| Address2: | |||||||||
| City: | APPLETON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549113487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9207491171 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 34305 | WI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 391682233013 | 01 | WI | BCBS | OTHER | 31940400 | 05 | WI | MEDICAID | W007233 | 01 | WI | CHAMPUS | OTHER |