Healthcare Provider Details

I. General information

NPI: 1841244761
Provider Name (Legal Business Name): JEANNE L PALLAGI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 WALNUT RIDGE DR
HARTLAND WI
53029-9385
US

IV. Provider business mailing address

3301 W FOREST HOME AVE
MILWAUKEE WI
53215-2843
US

V. Phone/Fax

Practice location:
  • Phone: 262-369-7040
  • Fax:
Mailing address:
  • Phone: 262-369-7040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number33418
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: