Provider Demographics
NPI:1861428070
Name:ALBERT, JOHN A (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:ALBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7080 N PORT WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-3838
Mailing Address - Country:US
Mailing Address - Phone:414-351-4009
Mailing Address - Fax:414-351-4009
Practice Address - Street 1:7080 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-3838
Practice Address - Country:US
Practice Address - Phone:414-351-4009
Practice Address - Fax:414-351-4009
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39779207RR0500X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32466600Medicaid
WI32466600Medicaid
WI002101473Medicare PIN
WI$$$$$$$$$007OtherANTHEM BLUE CROSS BLUE SH
H11681Medicare UPIN
WI32466600Medicaid