Individual
DR. GEORGE T POULLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10256 OLD GREEN BAY ROAD, PLEASANT PRAIRIE, WI 53158-2815
(262) 551-4200
(262) 551-4947
Mailing address
6308 8TH AVE, KENOSHA, WI 53143-5031
(262) 577-8320
(262) 577-8321
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
30486
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30486-20
WI LICENSE
WI
Enumeration date
08/23/2006
Last updated
03/07/2023
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