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Contact Information

JASON K BOUDREAU, DPM
2311 N PROSPECT AVE
MILWAUKEE, WI53211-4445
 Phone: 414-319-3000
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Podiatrist

213E00000X 48 Podiatry
Indicates primary specialty

NPI Profile & details for JASON K BOUDREAU · (Male)

NPI # 1518959378
Status Active
Credentials DPM (Doctor of Podiatric Medicine)
Entity Individual
Enumeration date 08/18/2005
Last updated 06/07/2012 - About 14 years ago
Sole proprietor 1 No
Identifiers
  • WI License # 803-025
  • WI Medicaid 43231600
Hospital affiliation(s)
  • COLUMBIA ST MARY'S HOSPITAL MILWAUKEE - (Acute Care)
    2323 N LAKE DR
    MILWAUKEE, WI 53211
  • COLUMBIA ST MARY'S HOSPITAL OZAUKEE INC - (Acute Care)
    13111 N PORT WASHINGTON RD
    MEQUON, WI 53097
  • ORTHOPAEDIC HSPTL OF WI - (Acute Care)
    475 W RIVER WOODS PKWY
    GLENDALE, WI 53212
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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