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NPI Code Detail

MEDICARE: ANDREA PETROWITZ MS, RD, CD

MEDICARE: ANDREA PETROWITZ MS, RD, CD
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
1133V00000XRegistered Dietitian2158-029WI

General Provider Information

NPI Number : 1871729764
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA PETROWITZ MS, RD, CD
Provider Business Mailing Address
First Line : 11333 W NATIONAL AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53227-3111
Country : US
Telephone Number : 414-328-4505
Fax Number : 414-389-5497
Provider Business Practice Location Address
First Line : 11333 W NATIONAL AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53227-3111
Country : US
Telephone Number : 414-328-4505
Fax Number : 414-389-5497
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2009
Last Update Date : 02/02/2016

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