Organization
MARY RADER CLINICAL DIETITIAN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY RADER C.D. (CERTIFIED DIETITIAN)
(414) 258-2255
Entity
Organization
Contact information
Practice address
611 N MAYFAIR RD, WAUWATOSA, WI 53226-4248
(414) 258-2255
Mailing address
611 N MAYFAIR RD, WAUWATOSA, WI 53226-4248
(414) 258-2255
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
827029
WI
Other
Enumeration date
07/22/2008
Last updated
09/12/2008
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