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General NPI Number Information
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NPI Number | 1154367811
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Entity Type | Individual
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Provider Name | HAROLD PENNINGTON DUCLOUX M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 12/22/2010
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Provider Practice Location Address
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Address Line | 10400 W NORTH AVVE SUITE 490 AMG MID-MARKET URGENT CARE GROUP
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City | WAUWATOSA
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State | WI
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Zip | 53226-5701
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Country | US
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Telephone | 414-479-3758
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Fax | 414-479-7254
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Provider Business Mailing Address
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Address Line | 10400 W NORTH AVVE SUITE 490 AMG MID-MARKET URGENT CARE GROUP
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City | WAUWATOSA
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State | WI
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Zip | 53226-5701
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Country | US
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Telephone | 414-479-3758
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Fax | 414-479-7254
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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 | 044708
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 51478-020
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License Number State | WI
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