Healthcare Provider Details

I. General information

NPI: 1912177858
Provider Name (Legal Business Name): DAVID R WINTER MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DAVID R WINTER MS

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10229 W GREENFIELD AVE
WEST ALLIS WI
53214-3911
US

IV. Provider business mailing address

10229 W GREENFIELD AVE
WEST ALLIS WI
53214-3911
US

V. Phone/Fax

Practice location:
  • Phone: 414-453-6330
  • Fax: 414-453-6523
Mailing address:
  • Phone: 414-453-6330
  • Fax: 414-453-6523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number145-058
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: