DR. JASON SCOTT PRUDOM (NPI# 1265775993) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265775993 |
| Entity Type | Individual |
| Full Name | DR. JASON SCOTT PRUDOM |
| Credential | M.D. |
| Practice Address |
3201 S 16th St Ste 2015 Milwaukee WI 53215-4532 |
| Mailing Address |
Greater Milwaukee Critical Care and Pulmonary Associate Po Box 070520 Milwaukee WI 53207-0520 |
| Practice Telephone | 4146493810 |
| Practice Fax Number | 2622400841 |
| Mailing Telephone | 4146493810 |
| Mailing Fax Number | 2622400841 |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2019-03-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RC0200X |
Internal Medicine Specialization: Critical Care Medicine |
63600-20 | WI | Allopathic & Osteopathic Physicians |
| Y | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
63600-20 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 100042547 | 05 |
| Street Address |
3201 S 16TH ST STE 2015 |
| City | MILWAUKEE |
| State | WI |
| Zip Code | 53215-4532 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386686905 | Irum Ziauddin | Physician Assistant | 3201 S 16th St Ste 2015, Milwaukee, WI 53215-4532 | 2006-06-11 |
| 1477817351 | Andrew Jason Zane | Internal Medicine | 3201 S 16th St Ste 2015, Milwaukee, WI 53215 | 2012-06-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841829918 | Joshua Michael Brooks | Student in an Organized Health Care Education/Training Program | Aurora St. Lukes Medical Center 2901 W Oklahoma Ave, Milwaukee, WI 53215 | 2020-04-02 |
| 1053967091 | Kristina Strupp | Clinical Nurse Specialist | 2900 W. Oaklahoma Avenue, Milwaukee, WI 53215 | 2019-08-15 |
| 1427510296 | Madelyn Pickle | Student in an Organized Health Care Education/Training Program | 2801 W. Kinnickinnic Rd Ste 250, Milwaukee, WI 53215 | 2019-04-02 |
| 1932601838 | Elizabeth D Morawski | Nurse Practitioner | 2801 Kinnickinnic Parkway, Suite 630, Milwaukee, WI 53215 | 2018-03-06 |
| 1457872673 | Canzata Kimberly Dent | Counselor | 2727 W. Cleveland Suite 204, Milwaukee, WI 53215 | 2017-06-28 |
| 1538689955 | Christian Pena | Durable Medical Equipment & Medical Supplies | 2800 W Forest Home Ave, Suite 100, Milwaukee, WI 53215 | 2017-06-27 |
| 1386178804 | Dane A Olsen | Family Medicine | 801 W Kinnickinnic River Pkwy., Suite 250, Milwaukee, WI 53215 | 2017-04-12 |
| 1811443492 | Thomas Diamond | Physical Therapist | 2901 Kinnickinnic Parkway, Milwaukee, WI 53215 | 2016-09-01 |
| 1487055133 | Sam Khalili | Otolaryngology | 2801 W Kinnickinnic River Pkwy # 680, Milwaukee, WI 53215 | 2014-09-12 |
| 1992105621 | Nicole R Hall | Nurse Practitioner | 2901 S Kinnickinnic Ave, Milwaukee, WI 53215 | 2014-08-29 |
| Find all providers in zip 53215 | ||||
| Taxonomy Code | 207RP1001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Pulmonary Disease |
| An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790307080 | Rihawi Md Sc | Internal Medicine | 2801 W Kinnickinnic River Pkwy Ste 445, Milwaukee, WI 53215-3669 | 2020-05-11 |
| 1699835256 | Stuart A Levy | Internal Medicine | 9509 N Wakefield Ct, Milwaukee, WI 53217-1245 | 2006-12-12 |
| 1861563058 | Omprakash Ahuja | Internal Medicine | 3070 N 51st Street, Suite 506, Milwaukee, WI 53210-1645 | 2006-11-11 |
| 1770005399 | Divyansh Bajaj | Internal Medicine | 8701 W Watertown Plank Rd, Milwaukee, WI 53226-3548 | 2017-07-14 |
| 1003268343 | Mohammed Omer Ahmed Abdalla | Internal Medicine | 8701 W Watertown Plank Rd Dept Of, Milwaukee, WI 53226-3548 | 2016-07-11 |
| 1114353737 | Bangash Medical Associates Sc | Internal Medicine | 7235 W Appleton Ave, Milwaukee, WI 53216-1932 | 2013-09-16 |
| 1750721346 | Uzair Khan Ghori | Internal Medicine | 9200 W Wisconsin Ave, Milwaukee, WI 53226-3522 | 2013-06-27 |
| 1497091003 | Milwaukee Medical Associates, Sc | Internal Medicine | 2741 W Layton Ave, #201, Milwaukee, WI 53221-2600 | 2012-12-31 |
| 1477817351 | Andrew Jason Zane | Internal Medicine | 3201 S 16th St Ste 2015, Milwaukee, WI 53215 | 2012-06-26 |
| 1992063226 | Jorge Leopoldo Sanchez | Internal Medicine | 9200 W Wisconsin Ave, Milwaukee, WI 53226-3522 | 2012-04-24 |
| Find all providers in MILWAUKEE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.