Individual
DR. AGNES PROSPERE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 E RYAN RD, OAK CREEK, WI 53154-4563
(414) 570-3590
Mailing address
PO BOX 735044, CHICAGO, IL 60673-4329
(414) 570-3590
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
80102-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100213444
—
WI
Enumeration date
03/25/2020
Last updated
10/26/2023
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