Healthcare Provider Details

I. General information

NPI: 1639528037
Provider Name (Legal Business Name): ANDREW CLITHERO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 WATERTOWN PLANK RD
MILWAUKEE WI
53226-3595
US

IV. Provider business mailing address

8700 WATERTOWN PLANK RD
MILWAUKEE WI
53226-3595
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-0437
  • Fax: 414-955-0093
Mailing address:
  • Phone: 414-955-0437
  • Fax: 414-955-0093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number71-321
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number71-321
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: