Organization
ELMBROOK PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY R. HAWORTH M.D. (PRESIDENT)
(262) 786-8199
Entity
Organization
Contact information
Practice address
17000 W NORTH AVE, SUITE 110E, BROOKFIELD, WI 53005-4423
(262) 786-8199
(262) 786-0769
Mailing address
17000 W NORTH AVE, SUITE 110E, BROOKFIELD, WI 53005-4423
(262) 786-8199
(262) 786-0769
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
68180
GROUP MEDICARE
WI
Enumeration date
04/27/2006
Last updated
08/22/2020
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