Individual
PAUL W MAMEROW
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
945 N 12TH ST, SUITE 4602, MILWAUKEE, WI 53233-1305
(414) 219-7450
Mailing address
945 N 12TH ST, SUITE 4602, MILWAUKEE, WI 53233-1305
(414) 219-7450
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1177-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42990300
—
WI
Enumeration date
06/14/2006
Last updated
07/08/2007
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