Individual
DR. EARNESTINE WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5433 W FOND DU LAC AVE, MIDTOWN PEDIATRICS, MILWAUKEE, WI 53216-1382
(414) 277-8900
(414) 277-8939
Mailing address
5433 W FOND DU LAC AVE, MIDTOWN PEDIATRICS, MILWAUKEE, WI 53216-1382
(414) 277-8900
(414) 277-8939
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
36231
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002000197O
HUMANA
—
05
—
1770535247
—
WI
Enumeration date
05/16/2006
Last updated
11/17/2016
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