Healthcare Provider Details

I. General information

NPI: 1578852687
Provider Name (Legal Business Name): ROBERT POETZEL D.V.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W BENDER RD
GLENDALE WI
53217-4301
US

IV. Provider business mailing address

211 W BENDER RD
GLENDALE WI
53217-4301
US

V. Phone/Fax

Practice location:
  • Phone: 414-962-8040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number3596-050
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: