Healthcare Provider Details

I. General information

NPI: 1417607136
Provider Name (Legal Business Name): MILESTONE PEDIATRICS, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20611 WATERTOWN RD STE D&E
WAUKESHA WI
53186-1871
US

IV. Provider business mailing address

20611 WATERTOWN RD STE D & E
WAUKESHA WI
53186-1871
US

V. Phone/Fax

Practice location:
  • Phone: 262-256-0676
  • Fax:
Mailing address:
  • Phone: 622-256-0676
  • Fax: 262-205-4210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AMY M LAUTZ
Title or Position: OWNER / PRESIDENT
Credential: MD
Phone: 414-241-5730