Individual
MR. TODD ANDREW BOUTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226
(414) 805-6450
(414) 805-6464
Mailing address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-6450
(414) 805-6464
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2386
WI
363A00000X
Physician Assistant
PA02219
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518986280
—
WI
Enumeration date
07/19/2006
Last updated
08/08/2018
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