Mortensen, Gordon L

Mortensen, Gordon L is an individual health care provider with primary practice located at 2900 W Oklahoma Ave , Milwaukee WI 53215-4330. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Anesthesiology, Allopathic & Osteopathic Physicians / Pain Medicine. Allopathic & Osteopathic Physicians / Pain Medicine is his primary health care specialty. Mortensen, Gordon L can be contacted via phone (414) 649-6000.

Contact Information

Primary practice address
2900 W Oklahoma Ave Milwaukee WI 53215-4330
Phone: (414) 649-6000
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X 26157-020 Wisconsin
Allopathic & Osteopathic Physicians / Pain Medicine 207LP2900X 26157-020 Wisconsin

Profile Details

NPI number 1407830862
LBN Legal business name Mortensen, Gordon L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 30th, 2005
Last updated Nov 24th, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407830862 NPPES
Wisconsin MEDICAID 30723700

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