Organization
LORELLE M MANION, MD, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORELLE MICHELLE MANION M.D. (PRESIDENT)
(262) 784-3200
Entity
Organization
Contact information
Practice address
1305 N BARKER RD, SUITE 1, BROOKFIELD, WI 53045-5230
(262) 784-3200
(262) 784-8198
Mailing address
PO BOX 5005, WAUKESHA, WI 53187-5005
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
35609
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32207500
—
WI
01
—
35609
WISCONSIN STATE LICENSE
WI
Enumeration date
05/17/2007
Last updated
08/22/2020
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