Individual
LEI LEI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10625 W NORTH AVE, SUITE 102, WAUWATOSA, WI 53226-2315
(414) 877-5351
(414) 877-5361
Mailing address
10625 W NORTH AVE, SUITE 102, WAUWATOSA, WI 53226-2315
(414) 877-5351
(414) 877-5361
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
56922
WI
Other
Enumeration date
03/27/2009
Last updated
09/11/2014
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