Basic Information
| Provider Information | |||||||||
| NPI: | 1255741948 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BELLMAN | ||||||||
| FirstName: | MEGAN | ||||||||
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| Credential: | PAS-2 | ||||||||
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| Mailing Information | |||||||||
| Address1: | N91W15750 FALLS PKWY | ||||||||
| Address2: | NEUROSURGERY | ||||||||
| City: | MENOMONEE FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530512301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2625321100 | ||||||||
| FaxNumber: | 2625321409 | ||||||||
| Practice Location | |||||||||
| Address1: | N91W15750 FALLS PKWY | ||||||||
| Address2: | NEUROSURGERY | ||||||||
| City: | MENOMONEE FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530512301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2625321100 | ||||||||
| FaxNumber: | 2625321409 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2014 | ||||||||
| LastUpdateDate: | 09/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 1255741948 | 05 | WI | MEDICAID |