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Individual

DR. BRIAN MICHAEL FIDLIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PSYD

Contact information

Practice address
9000 W WISCONSIN AVE, MILWAUKEE, WI 53226-4874
(414) 805-3666
Mailing address
10000 W INNOVATION DR, MILWAUKEE, WI 53226-4837
(414) 456-5006
(414) 456-6259

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2506057
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
39756800
WI
Enumeration date
08/22/2006
Last updated
09/27/2007
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