Individual
MR. MYLES FISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
770 N 12TH ST, MILWAUKEE, WI 53233-2203
(414) 288-3067
Mailing address
3205 N KNOLL TER, WAUWATOSA, WI 53222-3366
(414) 659-2973
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
11/11/2019
Last updated
11/11/2019
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