Individual
FNU MARIUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4202 W OAKWOOD PARK CT, FRANKLIN, WI 53132-9118
(414) 423-5250
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2017022833
MO
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
83693-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100295765
—
WI
Enumeration date
07/10/2014
Last updated
12/09/2024
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