Basic Information
| Provider Information | |||||||||
| NPI: | 1336256676 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RASMUSSEN | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RASMUSSEN | ||||||||
| OtherFirstName: | PAUL | ||||||||
| OtherMiddleName: | DAVID | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9200 W WISCONSIN AVE | ||||||||
| Address2: | PO BOX 26099 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532260099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4148057408 | ||||||||
| FaxNumber: | 4148057408 | ||||||||
| Practice Location | |||||||||
| Address1: | 9200 W WISCONSIN AVE | ||||||||
| Address2: | DEPARTMENT OF ORTHOPAEDIC SURGERY | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532260099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4148057410 | ||||||||
| FaxNumber: | 4148057499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 10/29/2012 | ||||||||
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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 | 207X00000X | 23849 | WI | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1336256676 | 05 | WI | MEDICAID | AR1133432 | 01 | DEA NUMBER | OTHER | 30683600 | 05 | WI | MEDICAID |