MEDICARE: MR. JAMES A MORTELL PA

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	363AM0700X	Medical Physician Assistant	258023	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	:	1952312746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES A MORTELL PA

Provider Business Mailing Address
First Line	:	2600 N MAYFAIR RD
Second Line	:	SUITE 901
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-1309
Country	:	US
Telephone Number	:	414-778-4976
Fax Number	:	414-778-3445

Provider Business Practice Location Address
First Line	:	2600 N MAYFAIR RD
Second Line	:	SUITE 901
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-1309
Country	:	US
Telephone Number	:	414-778-4976
Fax Number	:	414-778-3445

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/09/2007

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Directions to “ MR. JAMES A MORTELL PA” Practice Location

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