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General NPI Number Information
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NPI Number | 1073257465
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Entity Type | Organization
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Legal Business Name | DRALA TELEMEDICINE LLC
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Dates
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Enumeration Date | 04/22/2022
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Last Update Date | 04/22/2022
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Provider Practice Location Address
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Address Line | 8254 S PRESERVE WAY
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City | FRANKLIN
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State | WI
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Zip | 53132-7102
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Country | US
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Telephone | 414-708-7465
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Fax |
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Provider Business Mailing Address
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Address Line | 8254 S PRESERVE WAY
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City | FRANKLIN
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State | WI
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Zip | 53132-7102
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Country | US
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Telephone | 414-708-7465
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Fax |
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Authorized Official
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Title or Position | OWNER, AUTHORIZED OFFICIAL
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Name | CHRISTOPHER JOHN WITHERS
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Credential | DO
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Telephone | 414-708-7465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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