1770707358 NPI number — DR. JEFFREY PAUL BEJMA MD

Table of content: DR. JEFFREY PAUL BEJMA MD (NPI 1770707358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770707358 NPI number — DR. JEFFREY PAUL BEJMA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEJMA
Provider First Name:
JEFFREY
Provider Middle Name:
PAUL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770707358
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
W129N7055 NORTHFIELD DR
Provider Second Line Business Mailing Address:
COMMUNITY MEMORIAL MEDICAL COMMONS
Provider Business Mailing Address City Name:
MENOMONEE FALLS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53051-0538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-253-5400
Provider Business Mailing Address Fax Number:
262-253-3399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
W129N7055 NORTHFIELD DR
Provider Second Line Business Practice Location Address:
COMMUNITY MEMORIAL MEDICAL COMMONS
Provider Business Practice Location Address City Name:
MENOMONEE FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53051-0538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-253-5400
Provider Business Practice Location Address Fax Number:
262-253-3399
Provider Enumeration Date:
04/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  026270 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: 56116 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1770707358 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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