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Individual

NEIL JAMES RENNICK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
3066 MAIN ST # 45, EAST TROY, WI 53120-1148
(262) 642-7313
(262) 642-4251
Mailing address
PO BOX 45, 3066 MAIN ST, EAST TROY, WI 53120-0045
(262) 642-7313
(262) 642-4251

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
26462
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
26462
LICENSE NUMBER
WI
05
30100300
WI
Enumeration date
06/22/2007
Last updated
04/06/2010
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