Individual
CHARLOTTE FORMELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9000 W WISCONSIN AVENUE, MILWAUKEE, WI 53226-4874
(414) 337-7050
(414) 337-7020
Mailing address
9000 W WISCONSIN AVENUE, MILWAUKEE, WI 53226-4874
(414) 337-7050
(414) 337-7020
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
76538
WI
208M00000X
Hospitalist Physician
76538
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487210076
—
WI
Enumeration date
05/20/2019
Last updated
04/05/2024
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