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General NPI Number Information
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NPI Number | 1205355500
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Entity Type | Organization
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Legal Business Name | FROEDTERT HEALTH
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Dates
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Enumeration Date | 09/18/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 4850 S 60TH ST
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City | GREENFIELD
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State | WI
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Zip | 53220-4616
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Country | US
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Telephone | 414-777-3463
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Fax |
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Provider Business Mailing Address
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Address Line | W129N7055 NORTHFIELD DRIVE
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PA
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Name | MRS. ANGELA MONTOTO
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Credential | PA
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Telephone | 414-777-3463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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