Individual
MR. DOUGLAS JEROME WOIDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS PAS, PA-C
Contact information
Practice address
8500 W CAPITOL DR STE 100, MILWAUKEE, WI 53222-1869
(414) 431-5004
(414) 431-2959
Mailing address
1214 ORIOLE DR, OCONOMOWOC, WI 53066-2373
(414) 759-4111
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1865
WI
363AM0700X
Medical Physician Assistant
1865-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790823045
—
WI
Enumeration date
02/01/2007
Last updated
01/18/2019
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