Organization
THERESA PARDOE D.O.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA MARIE PARDOE D.O. (OWNER)
(414) 545-1120
Entity
Organization
Contact information
Practice address
9305 W NATIONAL AVE, WEST ALLIS, WI 53227-1541
(414) 545-1120
(414) 545-2505
Mailing address
9305 W NATIONAL AVE, WEST ALLIS, WI 53227-1541
(414) 545-1120
(414) 545-2505
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
29660
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31462700
—
WI
01
—
479701014009
BLUE CROSS
—
Enumeration date
07/22/2006
Last updated
07/22/2007
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