MEDICARE: ANTHONY NORELLI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35163	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093788176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY NORELLI M.D.

Provider Business Mailing Address
First Line	:	WAUKESHA HEALTH CARE INC.
Second Line	:	N17 W24100 RIVERWOOD DRIVE SUITE 250
City	:	WAUKESHA
State	:	WI
Zip	:	53188-1177
Country	:	US
Telephone Number	:	262-928-4100
Fax Number	:	262-928-5835

Provider Business Practice Location Address
First Line	:	PROHEALTH CARE MEDICAL CENTERS-MUKWONAGO
Second Line	:	240 MAPLE AVENUE
City	:	MUKWONAGO
State	:	WI
Zip	:	53149
Country	:	US
Telephone Number	:	262-928-1900
Fax Number	:	262-363-1949

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	10/17/2007

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