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NPI Code Detail

MEDICARE: DR. GEORGE MOLEMO MONESE MD

MEDICARE: DR. GEORGE MOLEMO MONESE MD
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
12084P0800XPsychiatry Physician39290-020WI

General Provider Information

NPI Number : 1215049077
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GEORGE MOLEMO MONESE MD
Provider Business Mailing Address
First Line : W7006 RIMROCK LN
Second Line :
City : GREENVILLE
State : WI
Zip : 54942-8764
Country : US
Telephone Number : 920-757-1939
Fax Number :
Provider Business Practice Location Address
First Line : 9455 W WATERTOWN PLANK RD
Second Line :
City : MILWAUKEE
State : WI
Zip : 53226-3559
Country : US
Telephone Number : 414-257-7260
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 07/08/2007

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