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Milwaukee, Wisconsin

Provider NPI: 1720143894

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
3201 S 16TH ST SUITE 200 MILWAUKEE, WI 53215 US
Tel: 414-384-5581  Fax: 414-384-5644

Business Mailing Address:
3201 S 16TH ST SUITE 200 MILWAUKEE, WI 53215 US
Tel: 414-384-5581  Fax: 414-384-5644

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Psychiatry & Neurology

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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