Healthcare Provider Details

I. General information

NPI: 1053408294
Provider Name (Legal Business Name): DONNA PITTER MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 W CENTER ST #200
MILWAUKEE WI
53210-2154
US

IV. Provider business mailing address

7 CLYDE RD
SOMERSET NJ
08873-5049
US

V. Phone/Fax

Practice location:
  • Phone: 414-442-7900
  • Fax: 414-442-8156
Mailing address:
  • Phone: 866-266-6822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DONNA E PITTER
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 414-442-7900