Provider Demographics
NPI:1104925965
Name:HUMES, PAMELA WILSON (DPM)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:WILSON
Last Name:HUMES
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:RENEE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4441 N 41ST ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-5815
Mailing Address - Country:US
Mailing Address - Phone:206-972-9997
Mailing Address - Fax:773-770-0141
Practice Address - Street 1:3915 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2528
Practice Address - Country:US
Practice Address - Phone:414-444-9242
Practice Address - Fax:414-444-9252
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI890-025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43237100Medicaid
WIP00148211OtherRAILROAD
WIP00148211OtherRAILROAD
V01704Medicare UPIN