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General NPI Number Information
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NPI Number | 1265542948
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Entity Type | Individual
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Provider Name | NOAH JEANNETTE DO
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 09/23/2022
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Provider Practice Location Address
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Address Line | 1525 N 12TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53205-2591
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Country | US
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Telephone | 414-966-3030
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Fax |
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Provider Business Mailing Address
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Address Line | 3301 W FOREST HOME AVE
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City | MILWAUKEE
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State | WI
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Zip | 53215-2843
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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 |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 67385
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0S9252
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License Number State | FL
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