Individual
MATTHEW WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4625 N 40TH ST, MILWAUKEE, WI 53209-5809
(414) 750-1689
Mailing address
4625 N 40TH ST, MILWAUKEE, WI 53209-5809
(414) 750-1689
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
04/13/2023
Last updated
04/13/2023
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