Healthcare Provider Details

I. General information

NPI: 1093788176
Provider Name (Legal Business Name): ANTHONY NORELLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PROHEALTH CARE MEDICAL CENTERS-MUKWONAGO 240 MAPLE AVENUE
MUKWONAGO WI
53149
US

IV. Provider business mailing address

WAUKESHA HEALTH CARE INC. N17 W24100 RIVERWOOD DRIVE SUITE 250
WAUKESHA WI
53188-1177
US

V. Phone/Fax

Practice location:
  • Phone: 262-928-1900
  • Fax: 262-363-1949
Mailing address:
  • Phone: 262-928-4100
  • Fax: 262-928-5835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35163
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: