Healthcare Provider Details

I. General information

NPI: 1093377335
Provider Name (Legal Business Name): MAGGIE ELIZABETH WALSH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 W VILLARD AVE
MILWAUKEE WI
53209-4901
US

IV. Provider business mailing address

735 W WISCONSIN AVE APT 1204
MILWAUKEE WI
53233-2445
US

V. Phone/Fax

Practice location:
  • Phone: 414-527-8191
  • Fax:
Mailing address:
  • Phone: 312-804-6473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: