Organization
IN-YOUR-HOME MEDICINE & GERIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAWN DOUGLAS ANTLE MD (PRESIDENT)
(414) 795-6480
Entity
Organization
Contact information
Practice address
3915 N RIDGEFIELD CIR, SHOREWOOD, WI 53211-2451
(414) 795-6480
Mailing address
PO BOX 11544, SHOREWOOD, WI 53211-0544
(414) 795-6480
(414) 906-1758
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
46666
WI
Other
Enumeration date
08/31/2006
Last updated
08/22/2020
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