Basic Information
| Provider Information | |||||||||
| NPI: | 1710189121 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TENNENBAUM | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4425 N PORT WASHINGTON ROAD | ||||||||
| Address2: | CSMCP CLINIC CREDENTIALING | ||||||||
| City: | GLENDALE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532121082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143262378 | ||||||||
| FaxNumber: | 4143262155 | ||||||||
| Practice Location | |||||||||
| Address1: | 2320 N LAKE DRIVE | ||||||||
| Address2: | ROOM 3603 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532114507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142704932 | ||||||||
| FaxNumber: | 4142915195 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2007 | ||||||||
| LastUpdateDate: | 10/24/2012 | ||||||||
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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 | 207R00000X | 125050204 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.