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General NPI Number Information
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NPI Number | 1184648453
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Entity Type | Organization
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Legal Business Name | GLENDALE ANESTHESIA ASSOCIATES
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 01/29/2015
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Provider Practice Location Address
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Address Line | 575 WEST RIVER WOODS PARKWAY
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City | GLENDALE
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State | WI
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Zip | 53212
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Country | US
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Telephone | 414-961-6700
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Fax | 414-961-6727
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Provider Business Mailing Address
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Address Line | 4555 WEST SCHROEDER DRIVE SUITE 170
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City | MILWAUKEE
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State | WI
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Zip | 53223
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Country | US
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Telephone | 414-365-3210
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Fax | 414-365-3225
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Authorized Official
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Title or Position | PRESIDENT
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Name | JENNIFER WENNIGER NIEDFELDT
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Credential | MD
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Telephone | 414-365-3210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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