Healthcare Provider Details

I. General information

NPI: 1215067665
Provider Name (Legal Business Name): PATTIS MEDICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 W LISBON AVE
MILWAUKEE WI
53210-2116
US

IV. Provider business mailing address

6040 W LISBON AVE
MILWAUKEE WI
53210-2116
US

V. Phone/Fax

Practice location:
  • Phone: 414-447-9890
  • Fax:
Mailing address:
  • Phone: 414-447-9890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37017-020
License Number StateWI

VIII. Authorized Official

Name: DR. SUSAN E PATTIS
Title or Position: OWNER
Credential: M.D.
Phone: 414-447-9890