Individual
RUSSELL S GONNERING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2900 W OKLAHOMA AVE, MILWAUKEE, WI 53215-4330
(262) 754-9921
Mailing address
2448 S 102ND ST, SUITE 125, WEST ALLIS, WI 53227-2466
(414) 328-3812
(414) 328-3818
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
20265-020
WI
Other
Enumeration date
02/15/2006
Last updated
12/05/2007
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