Individual
ELIZABETH GANTENBEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-6966
(414) 805-6980
Mailing address
1155 N MAYFAIR RD, SPINE CARE CLINIC, WAUWATOSA, WI 53226-3462
(414) 955-7199
(414) 955-0110
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3330-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720496771
—
WI
Enumeration date
07/22/2014
Last updated
06/29/2022
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