Healthcare Provider Details

I. General information

NPI: 1699714832
Provider Name (Legal Business Name): ROBERT N HOLDEFER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8832 N PORT WASHINGTON RD SUITE 240
MILWAUKEE WI
53217-1628
US

IV. Provider business mailing address

8832 N PORT WASHINGTON RD SUITE 240
MILWAUKEE WI
53217-1628
US

V. Phone/Fax

Practice location:
  • Phone: 414-351-6666
  • Fax: 414-351-6999
Mailing address:
  • Phone: 414-351-6666
  • Fax: 414-351-6999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: