Provider Demographics
NPI:1679715148
Name:MOOREN-BOESHAAR, PAMELA ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ELIZABETH
Last Name:MOOREN-BOESHAAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3070 N 51ST ST
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1645
Mailing Address - Country:US
Mailing Address - Phone:414-445-6520
Mailing Address - Fax:414-445-6875
Practice Address - Street 1:3070 N 51ST ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1645
Practice Address - Country:US
Practice Address - Phone:414-445-6520
Practice Address - Fax:414-445-6875
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2013-11-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI55554-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine