Individual
MARY ELIZABETH DEWATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
210 W CAPITOL DR, MILWAUKEE, WI 53212-3732
(144) 906-5306
(144) 906-4533
Mailing address
210 W CAPITOL DR., MILWAUKEE, WI 53212-3732
(414) 906-5306
(144) 906-4533
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
64204
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235572447
—
WI
Enumeration date
04/08/2013
Last updated
01/15/2020
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