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:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1407830862 | NPPES |
| Wisconsin | MEDICAID | 30723700 |
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