Healthcare Provider Details

I. General information

NPI: 1881859619
Provider Name (Legal Business Name): MICHAEL JOHN AEHL LMT, LAC., MSOM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 HILLSIDE DR SUITE A
DELAFIELD WI
53018-2165
US

IV. Provider business mailing address

2725 HILLSIDE DR SUITE A
DELAFIELD WI
53018-2165
US

V. Phone/Fax

Practice location:
  • Phone: 262-646-2123
  • Fax: 262-646-5615
Mailing address:
  • Phone: 262-646-2123
  • Fax: 262-646-5615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1017-046
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number308-055
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: