Individual
DR. MARY GRACE HERNANDEZ LASQUETY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2311 N PROSPECT AVE, MILWAUKEE, WI 53211-4445
(414) 319-3000
(414) 319-3033
Mailing address
4425 N PORT WASHINGTON RD, GLENDALE, WI 53212-1082
(414) 319-3000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
56635
WI
Other
Enumeration date
04/16/2009
Last updated
08/20/2015
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