Healthcare Provider Details

I. General information

NPI: 1750335022
Provider Name (Legal Business Name): MARGARET LOCKWOOD PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COLUMBIA-ST. MARY'S FAMILY PRACTICE 1121 EAST NORTH AVENUE
MILWAUKEE WI
53212
US

IV. Provider business mailing address

1121 E NORTH AVE COLUMBIA-ST. MARY'S FAMILY PRACTICE
MILWAUKEE WI
53212-3515
US

V. Phone/Fax

Practice location:
  • Phone: 414-267-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number741
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: