Healthcare Provider Details

I. General information

NPI: 1013778588
Provider Name (Legal Business Name): DR. CHRISTOPHER JOSEPH DAOOD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/22/2024
Certification Date: 01/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 W RIVERVIEW DR
GLENDALE WI
53209-4534
US

IV. Provider business mailing address

950 W RIVERVIEW DR
GLENDALE WI
53209-4534
US

V. Phone/Fax

Practice location:
  • Phone: 414-617-3704
  • Fax:
Mailing address:
  • Phone: 414-617-3704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3084-57
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: