Individual
TANRITAI WYLLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
8375 S HOWELL AVE, OAK CREEK, WI 53154-8344
(414) 764-5726
(414) 764-6954
Mailing address
8375 S HOWELL AVE, OAK CREEK, WI 53154-8344
(414) 764-5726
(414) 764-6954
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
53900
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1598938912
—
WI
Enumeration date
04/07/2008
Last updated
06/23/2014
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