Healthcare Provider Details

I. General information

NPI: 1023191921
Provider Name (Legal Business Name): JANE MARIE COLLIS-GEERS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2906 S 20TH ST
MILWAUKEE WI
53215-3732
US

IV. Provider business mailing address

2906 S 20TH ST
MILWAUKEE WI
53215-3732
US

V. Phone/Fax

Practice location:
  • Phone: 414-672-1353
  • Fax: 414-385-7552
Mailing address:
  • Phone: 414-672-1353
  • Fax: 414-385-7552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number20376
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: