Basic Information
| Provider Information | |||||||||
| NPI: | 1932188943 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WERNER | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2901 W KINNICKINNIC RIVER PKWY | ||||||||
| Address2: | #310 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532153677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4146493990 | ||||||||
| FaxNumber: | 4146493969 | ||||||||
| Practice Location | |||||||||
| Address1: | 2901 W KINNICKINNIC RIVER PKWY | ||||||||
| Address2: | #310 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532153677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4146493990 | ||||||||
| FaxNumber: | 4146493969 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 12/26/2008 | ||||||||
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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 | 208G00000X | 20192 | WI | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 30519600 | 05 | WI | MEDICAID |