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General NPI Number Information
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NPI Number | 1447356845
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Entity Type | Organization
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Legal Business Name | LIFETIME OB/GYN, LTD.
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 17280 W NORTH AVE SUITE 200
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City | BROOKFIELD
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State | WI
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Zip | 53045-4366
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Country | US
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Telephone | 262-754-8000
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Fax | 262-754-8008
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Provider Business Mailing Address
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Address Line | 17280 W NORTH AVE SUITE 200
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City | BROOKFIELD
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State | WI
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Zip | 53045-4366
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Country | US
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Telephone | 262-754-8000
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Fax | 262-754-8008
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOANNE METOFF
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Credential | M.D.
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Telephone | 262-754-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 283200
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License Number State | WI
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