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General NPI Number Information
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NPI Number | 1417607136
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Entity Type | Organization
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Legal Business Name | MILESTONE PEDIATRICS, SC
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Dates
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Enumeration Date | 03/25/2022
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Last Update Date | 08/25/2022
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Provider Practice Location Address
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Address Line | 20611 WATERTOWN RD STE D&E
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City | WAUKESHA
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State | WI
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Zip | 53186-1871
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Country | US
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Telephone | 262-256-0676
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Fax |
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Provider Business Mailing Address
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Address Line | 20611 WATERTOWN RD STE D & E
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City | WAUKESHA
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State | WI
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Zip | 53186-1871
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Country | US
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Telephone | 622-256-0676
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Fax | 262-205-4210
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Authorized Official
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Title or Position | OWNER / PRESIDENT
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Name | AMY M LAUTZ
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Credential | MD
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Telephone | 414-241-5730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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