Individual
ELISSA BETHMARIE PORATH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
945 N 12TH ST, MILWAUKEE, WI 53233-1305
(414) 219-2000
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843
(414) 219-2000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5630
WI
Other
Enumeration date
03/09/2021
Last updated
01/03/2022
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