Provider Demographics
NPI:1043306731
Name:FAISON, BARBARA-ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:BARBARA-ANNE
Middle Name:
Last Name:FAISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 W. NORTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53205-1134
Mailing Address - Country:US
Mailing Address - Phone:414-374-9575
Mailing Address - Fax:414-586-9282
Practice Address - Street 1:7810 WEST GOOD HOPE ROAD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-4518
Practice Address - Country:US
Practice Address - Phone:414-586-9255
Practice Address - Fax:414-586-9282
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24910208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1043306731Medicaid
WI000073845Medicare ID - Type Unspecified
1043306731Medicare NSC
WIB52694Medicare UPIN
WI1043306731Medicaid