Healthcare Provider Details

I. General information

NPI: 1730399130
Provider Name (Legal Business Name): KAREN A MAISONET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N 92ND ST
MILWAUKEE WI
53226-3533
US

IV. Provider business mailing address

2414A N WAUWATOSA AVE
WAUWATOSA WI
53213-1133
US

V. Phone/Fax

Practice location:
  • Phone: 414-479-9400
  • Fax: 414-259-1663
Mailing address:
  • Phone: 414-479-9400
  • Fax: 414-259-1663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberM253-5016-2687-03
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: