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General NPI Number Information
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NPI Number | 1508062043
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Entity Type | Individual
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Provider Name | NEIL JAMES RENNICK DO
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Gender | Male
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 04/06/2010
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Provider Practice Location Address
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Address Line | 3066 MAIN ST # 45
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City | EAST TROY
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State | WI
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Zip | 53120-1148
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Country | US
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Telephone | 262-642-7313
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Fax | 262-642-4251
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Provider Business Mailing Address
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Address Line | PO BOX 45 3066 MAIN ST
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City | EAST TROY
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State | WI
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Zip | 53120-0045
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Country | US
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Telephone | 262-642-7313
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Fax | 262-642-4251
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 26462
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License Number State | WI
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