Individual
MARK A GENNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1020 N 12TH ST, 2ND FLOOR, MILWAUKEE, WI 53233-1308
(414) 219-7724
Mailing address
10133 N SHERIDAN DR, MEQUON, WI 53092-6119
(414) 241-8652
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
26971-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30676400
—
WI
Enumeration date
01/08/2007
Last updated
07/08/2007
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