Healthcare Provider Details

I. General information

NPI: 1912246323
Provider Name (Legal Business Name): JILL P WOHLFEIL MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2013
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W359N5002 BROWN ST SUITE 208
OCONOMOWOC WI
53066-3366
US

IV. Provider business mailing address

4555 W SCHROEDER DR SUITE 170
MILWAUKEE WI
53223-1475
US

V. Phone/Fax

Practice location:
  • Phone: 262-560-1920
  • Fax: 262-567-4736
Mailing address:
  • Phone: 414-365-3210
  • Fax: 414-365-3225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number34188
License Number StateWI

VIII. Authorized Official

Name: DR. JILL P WOHLFEIL
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 262-560-1920