Healthcare Provider Details

I. General information

NPI: 1871888214
Provider Name (Legal Business Name): LAURA K CICUTO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA L KLOUDA M.D.

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 06/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E WISCONSIN AVE SUITE 2000
MILWAUKEE WI
53202-4815
US

IV. Provider business mailing address

111 E WISCONSIN AVE SUITE 2000
MILWAUKEE WI
53202-4815
US

V. Phone/Fax

Practice location:
  • Phone: 414-290-6715
  • Fax: 414-290-6755
Mailing address:
  • Phone: 414-290-6715
  • Fax: 414-290-6755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number61938-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: