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General NPI Number Information
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NPI Number | 1437319142
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Entity Type | Organization
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Legal Business Name | MEDICAL GENETICS INSTITUTE, S.C.
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Dates
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Enumeration Date | 06/16/2008
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 2311 W GOOD HOPE RD
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City | GLENDALE
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State | WI
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Zip | 53209-2735
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Country | US
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Telephone | 414-228-0100
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Fax | 414-228-8774
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Provider Business Mailing Address
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Address Line | 2311 W GOOD HOPE RD
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City | GLENDALE
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State | WI
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Zip | 53209-2735
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Country | US
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Telephone | 414-228-0100
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Fax | 414-228-8774
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MRS. MARIA M DE ELEJALDE
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Credential | M.S., R.N.
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Telephone | 414-228-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 170100000X
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Taxonomy Name | Ph.D. Medical Genetics
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License Number | 21932-020
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License Number State | WI
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