Healthcare Provider Details

I. General information

NPI: 1861779563
Provider Name (Legal Business Name): MELANIE UNGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14555 W NATIONAL AVE STE 135
NEW BERLIN WI
53151-4483
US

IV. Provider business mailing address

7936 W BARNARD AVE
GREENFIELD WI
53220-4228
US

V. Phone/Fax

Practice location:
  • Phone: 262-827-3180
  • Fax:
Mailing address:
  • Phone: 608-513-1385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1297-039
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: