Wideburg, Eric
Wideburg, Eric is an individual health care provider with primary practice located at W231N1440 Corporate Ct , Waukesha WI 53186-1303. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Wideburg, Eric can be contacted via phone (262) 896-6000.Contact Information
Primary practice address
W231N1440 Corporate Ct
Waukesha WI 53186-1303
Phone: (262) 896-6000
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 72422-21 | Wisconsin |
Profile Details
| NPI number | 1679004469 |
|---|---|
| LBN Legal business name | Wideburg, Eric |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 23rd, 2017 |
| Last updated | Mar 27th, 2025 - about last year |
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 | 1679004469 | NPPES |
| Wisconsin | MEDICAID | 100096055 |
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