DR. JASON K. BOUDREAU (NPI# 1518959378) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518959378 |
| Entity Type | Individual |
| Full Name | DR. JASON K. BOUDREAU |
| Credential | D.P.M. |
| Practice Address |
2311 N Prospect Ave Milwaukee WI 53211-4445 |
| Mailing Address |
4425 N Port Washington Rd Attn: Csmcp Clinic Credentialing Glendale WI 53212-1082 |
| Practice Telephone | 4143193000 |
| Mailing Telephone | 4143193000 |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2012-06-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213E00000X | Podiatrist | 803-025 | WI | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 43231600 | 05 |
| Street Address |
2311 N PROSPECT AVE |
| City | MILWAUKEE |
| State | WI |
| Zip Code | 53211-4445 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710983275 | James G Linn | Obstetrics & Gynecology | 2311 N Prospect Ave, Milwaukee, WI 53211-4445 | 2005-06-21 |
| 1235752353 | Maria Michelle Olex | Psychologist | 2311 N Prospect Ave, Milwaukee, WI 53211-4445 | 2020-05-22 |
| 1336785500 | Daniel Steven Chadwick | Physician Assistant | 2311 N Prospect Ave, Milwaukee, WI 53211-4445 | 2019-11-22 |
| 1154978310 | Linda Perez | Nurse Practitioner | 2311 N Prospect Ave, Milwaukee, WI 53211-4445 | 2019-08-22 |
| 1497228274 | Megan T Snyder | Registered Nurse | 2311 N Prospect Ave, Milwaukee, WI 53211-4445 | 2019-01-04 |
| 1477026185 | Gina Marie Hubacz | Nurse Practitioner | 2311 N Prospect Ave, Milwaukee, WI 53211-4445 | 2019-01-04 |
| 1730659343 | Lindsay Marie Witkowski | Nurse Practitioner | 2311 N Prospect Ave, Milwaukee, WI 53211-4445 | 2018-11-27 |
| 1679004980 | Kristin Janna Magliocco | Family Medicine | 2311 N Prospect Ave, Milwaukee, WI 53211-4445 | 2017-03-27 |
| 1811428303 | Bernard Nartey | Family Medicine | 2311 N Prospect Ave, Milwaukee, WI 53211-4445 | 2017-03-25 |
| 1699125385 | Lena Sharma | Family Medicine | 2311 N Prospect Ave, Milwaukee, WI 53211 | 2016-06-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821602335 | Gabriella Caitrin Emanuele | Occupational Therapist | Harborchase of Shorewood, 1111 E Capitol Drive, Shorewood, WI 53211 | 2020-09-02 |
| 1710527783 | Sage Specialty Pharmacy Inc. | Pharmacy | 4001 N. Oakland Ave, Shorewood, WI 53211 | 2020-01-08 |
| 1861043952 | Rosina Bloomingdale Norton | Nurse Practitioner | 1921 E Harford Ave, Milwaukee, WI 53211 | 2019-09-20 |
| 1528556255 | Renee Reckelberg | Specialist/Technologist | 3409 North Downer Avenue, Pavilion, Suite 350, Milwaukee, WI 53211 | 2018-04-27 |
| 1700325602 | Wisconsin Vision, Inc. | Optometrist | 4163 N Oakland Ave, Shorewood, WI 53211 | 2017-02-13 |
| 1750827556 | Daniel Butz M.d., S.c. | Plastic Surgery | 2350 N Lake Dr Ste 304, Milwaukee, WI 53211 | 2017-01-17 |
| 1528517232 | Therese Simonis | Speech-Language Pathologist | 2390 N Lake Drive, Milwaukee, WI 53211 | 2016-09-23 |
| 1982075701 | Katie Michel | Specialist/Technologist | 3409 N. Downer Ave, Milwaukee, WI 53211 | 2015-10-20 |
| 1255776365 | Sarah Elizabeth Brill | Social Worker | 4433 N Oakland Ave Ste D, Shorewood, WI 53211 | 2013-05-02 |
| 1679814537 | Nicole Anne Parulski | Physical Therapist | 2301 North Lake Dr, Milwaukee, WI 53211 | 2013-03-01 |
| Find all providers in zip 53211 | ||||
| Taxonomy Code | 213E00000X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073880936 | Tahir A Khan | Podiatrist | 6001 W Center St Ste 108, Milwaukee, WI 53210-2154 | 2011-11-21 |
| 1811185812 | John Stuart Lanham | Podiatrist | 5720 W Oklahoma Avenue, Milwaukee, WI 53219 | 2007-10-04 |
| 1326124694 | Alan L Balkansky Dpmsc | Podiatrist | 5404a N Lovers Lane Rd, Milwaukee, WI 53225-3006 | 2006-10-31 |
| 1295819118 | North Shore Podiatry, Inc. | Podiatrist | 8003 N Port Washington Rd, Milwaukee, WI 53217-2647 | 2006-10-25 |
| 1346251303 | Jeffrey A Fischer | Podiatrist | 9226 W Burleigh St, Milwaukee, WI 53222-3503 | 2006-08-11 |
| 1235165002 | Steven Eric Kaufman | Podiatrist | 3615 W Oklahoma Ave, Milwaukee, WI 53215-4100 | 2006-06-24 |
| 1457301228 | Steven Frydman | Podiatrist | 7929 N 76th St, Milwaukee, WI 53223-3947 | 2006-05-11 |
| 1427049279 | Community Foot and Ankle Clinic, Inc. | Podiatrist | 4100 S Howell Ave, Milwaukee, WI 53207-4410 | 2005-11-01 |
| 1174529671 | Warren K Mciver | Podiatrist | 7903 West Capitol Drive, Milwaukee, WI 53222-1903 | 2005-06-21 |
| 1952306896 | Louis Robert Lapow | Podiatrist | 4220 S 27th St, Ste 101, Milwaukee, WI 53221-1855 | 2005-06-16 |
| 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.