Basic Information
| Provider Information | |||||||||
| NPI: | 1770511099 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DAVID S ABELSON MDSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4555 WEST SCHROEDER DRIVE | ||||||||
| Address2: | SUITE 170 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143653210 | ||||||||
| FaxNumber: | 4143653225 | ||||||||
| Practice Location | |||||||||
| Address1: | 1834 W WISCONSIN AVENUE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4149339100 | ||||||||
| FaxNumber: | 4149339200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 03/26/2008 | ||||||||
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| AuthorizedOfficialLastName: | ABELSON | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4149339100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 32893200 | 05 | WI | MEDICAID |