Individual
DR. SHANNON PHEADRA ALLEN-GRYZWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
PREMISE HEALTHCARE MILLER HEALTH & FITNESS, 4400 W. STATE ST., MILWAUKEE, WI 53208
(262) 928-1900
Mailing address
240 MAPLE AVE, PROHEALTH CARE MEDICAL ASSOCIATES INC., MUKWONAGO, WI 53149-8475
(262) 928-1900
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
40073
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32639500
—
WI
Enumeration date
02/09/2006
Last updated
02/16/2024
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