| NPI | 1740469873 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBBIE MOKELKE Billing 414-545-7245 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 21142) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: WI 21142) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 21142) | |
| Enumeration Date | 2007-10-25 |
| Last Update Date | 2012-11-06 |