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Individual

EDDY D CO,

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3267 S 16TH ST, SUITE 105, MILWAUKEE, WI 53215-4500
(414) 645-0920
Mailing address
3267 S 16TH ST, SUITE 105, MILWAUKEE, WI 53215-4500
(414) 645-0920

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
19814
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
061917005
RAILROAD MEDICARE
WI
05
30914600
WI
Enumeration date
09/12/2006
Last updated
05/11/2010
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