Individual
ASA C MERRIWETHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1000 N 92ND ST, MILWAUKEE, WI 53226-3533
(414) 479-9400
(414) 259-1663
Mailing address
6369 N JOYCE AVE, MILWAUKEE, WI 53225-1950
(414) 479-9400
(414) 259-1663
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
M636-0034-4455-06
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DRR 0018990
PUBLIC PASSENGER LICENSE
WI
Enumeration date
05/22/2007
Last updated
07/08/2007
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