Provider Demographics
NPI:1285693648
Name:GOLDBAUM, ABE FRANK (MD)
Entity type:Individual
Prefix:
First Name:ABE
Middle Name:FRANK
Last Name:GOLDBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2928 MINOT LN
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-4451
Mailing Address - Country:US
Mailing Address - Phone:262-292-9091
Mailing Address - Fax:
Practice Address - Street 1:2900 W OKLAHOMA AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4330
Practice Address - Country:US
Practice Address - Phone:414-649-7710
Practice Address - Fax:414-649-7028
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34054-020208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33337700Medicaid
G07502Medicare UPIN
WI01588Medicare ID - Type UnspecifiedMILWAUKEE
WI33337700Medicaid
G07502Medicare UPIN