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General NPI Number Information
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NPI Number | 1023225042
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Entity Type | Organization
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Legal Business Name | LORELLE M MANION, MD, SC
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1305 N BARKER RD SUITE 1
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City | BROOKFIELD
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State | WI
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Zip | 53045-5230
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Country | US
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Telephone | 262-784-3200
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Fax | 262-784-8198
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Provider Business Mailing Address
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Address Line | PO BOX 5005
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City | WAUKESHA
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State | WI
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Zip | 53187-5005
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LORELLE MICHELLE MANION
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Credential | M.D.
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Telephone | 262-784-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 35609
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License Number State | WI
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