Individual
COLLEEN GLEASON SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9200 W WISCONSIN AVE, FROEDTERT & MEDICAL COLLEGE PRE-OP CLINIC, MILWAUKEE, WI 53226-3522
(414) 805-6250
(414) 805-7210
Mailing address
9200 W WISCONSIN AVE, FROEDTERT & MEDICAL COLLEGE PRE-OP CLINIC, MILWAUKEE, WI 53226-3522
(414) 805-6250
(414) 805-7210
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
4367-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518450915
—
WI
Enumeration date
06/11/2018
Last updated
04/12/2023
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