Individual
DR. PATRICK JAY DISTERHAFT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO, MPH
Contact information
Practice address
945 N 12TH ST, MILWAUKEE, WI 53233-1305
(414) 219-7136
(414) 219-6264
Mailing address
945 N 12TH ST, MILWAUKEE, WI 53233-1305
(414) 219-2000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
101658851
WI
Other
Enumeration date
06/27/2024
Last updated
06/24/2025
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