Individual
OUMOU FORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3351 S 51ST ST, MILWAUKEE, WI 53219-4516
(414) 460-6868
Mailing address
3351 S 51ST ST, MILWAUKEE, WI 53219-4516
(414) 460-6868
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
—
—
347C00000X
Private Vehicle
Primary
347C00000
WI
Other
Enumeration date
03/31/2016
Last updated
03/31/2016
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