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General NPI Number Information
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NPI Number | 1245013572
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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 | 08/18/2023
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Last Update Date | 08/18/2023
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Provider Practice Location Address
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Address Line | 841 N BROADWAY
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City | MILWAUKEE
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State | WI
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Zip | 53202-3640
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Country | US
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Telephone | 414-286-5079
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Fax |
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Provider Business Mailing Address
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Address Line | W129N7055 NORTHFIELD DR
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-0538
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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 | CFO
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Name | BLAINE JOHN O'CONNELL
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Credential |
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Telephone | 414-805-4291
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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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