Healthcare Provider Details

I. General information

NPI: 1235634353
Provider Name (Legal Business Name): LAURA EILEEN GOESER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. LAURA EILEEN SAMPSON

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-5320
  • Fax: 414-805-5323
Mailing address:
  • Phone: 414-805-5320
  • Fax: 414-805-5323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number71975-021
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number71975-021
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: