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General NPI Number Information
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NPI Number | 1154366367
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Entity Type | Individual
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Provider Name | DON D. AXT P.A.
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Gender | Male
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 08/26/2010
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Provider Practice Location Address
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Address Line | W180N8085 TOWN HALL RD 3SW SUITE 4
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-3518
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Country | US
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Telephone | 262-532-6899
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Fax |
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Provider Business Mailing Address
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Address Line | 3003 W GOOD HOPE RD
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City | MILWAUKEE
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State | WI
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Zip | 53209-2042
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Country | US
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Telephone | 414-352-3100
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 396
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License Number State | WI
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