Healthcare Provider Details

I. General information

NPI: 1275062085
Provider Name (Legal Business Name): STEPHANIE ANN WATTS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE ANN JOPPA MBBS

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
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: 414-805-6000
  • Fax: 414-805-6280
Mailing address:
  • Phone: 414-805-6000
  • Fax: 414-805-6280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number28495
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number75360-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: