Healthcare Provider Details

I. General information

NPI: 1871540518
Provider Name (Legal Business Name): LOUELLA B. AMOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE PEDIATRIC PULMONARY DISEASE
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

9000 W WISCONSIN AVE PEDIATRIC PULMONARY DISEASE
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-6730
  • Fax: 414-266-6742
Mailing address:
  • Phone: 414-266-6730
  • Fax: 414-266-6742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number47547
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: