Individual
DR. THERESA A MIKHAILOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9000 W WISCONSIN AVE, PEDIATRIC CRITICAL CARE, MILWAUKEE, WI 53226-4874
(414) 266-3360
(414) 266-3563
Mailing address
9000 W WISCONSIN AVE, PEDIATRIC CRITICAL CARE, MILWAUKEE, WI 53226-4874
(414) 266-3360
(414) 266-3563
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
40962
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002000329D
HUMANA
—
05
—
1679525356
—
WI
Enumeration date
05/17/2006
Last updated
09/24/2014
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