Organization
DEMATTIA MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAURE GRACE DEMATTIA D.O. (PRESIDENT)
(414) 431-8536
Entity
Organization
Contact information
Practice address
5500 W VLIET ST, MILWAUKEE, WI 53208-2120
(414) 431-8536
(414) 434-2049
Mailing address
5500 W VLIET ST, MILWAUKEE, WI 53208-2120
(414) 431-8536
(414) 434-2049
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
45995
WI
Other
Enumeration date
07/20/2007
Last updated
09/21/2007
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