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General NPI Number Information
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NPI Number | 1063583300
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Entity Type | Individual
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Provider Name | REBECCA Z GALLAGHER MD
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Gender | Female
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 09/11/2020
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Provider Practice Location Address
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Address Line | 4607 VETTELSON ROAD
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City | HARTLAND
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State | WI
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Zip | 53029
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Country | US
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Telephone | 262-367-1717
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Fax |
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Provider Business Mailing Address
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Address Line | 32645 WEST ESKER LN
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City | NASHOTAH
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State | WI
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Zip | 53058
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Country | US
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Telephone | 262-367-1717
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Fax | 262-458-4547
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 50254
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License Number State | WI
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