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General NPI Number Information
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NPI Number | 1407289275
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Entity Type | Individual
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Provider Name | ANDREW FRANCIS CHARLAND LMT
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Gender | Male
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Dates
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Enumeration Date | 08/15/2013
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Last Update Date | 08/15/2013
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Provider Practice Location Address
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Address Line | N168W22224 MAIN ST STE E
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City | JACKSON
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State | WI
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Zip | 53037-9321
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Country | US
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Telephone | 414-507-6857
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Fax |
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Provider Business Mailing Address
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Address Line | 9318 KETTLE MORAINE DR
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City | KEWASKUM
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State | WI
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Zip | 53040-9748
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Country | US
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Telephone | 414-507-6857
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 11601-146
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License Number State | WI
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