Healthcare Provider Details

I. General information

NPI: 1891975306
Provider Name (Legal Business Name): ANGELA LEA RABBITT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE DIVISION OF CHILD PROTECTION
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

9000 W WISCONSIN AVE DIVISION OF CHILD PROTECTION
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-2090
  • Fax: 414-266-3157
Mailing address:
  • Phone: 414-266-2090
  • Fax: 414-266-3157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2007001635
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License Number53048
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: