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General NPI Number Information
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NPI Number | 1508839838
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Entity Type | Individual
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Provider Name | MARY JO ROLFES-LO M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 200 E RYAN RD
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City | OAK CREEK
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State | WI
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Zip | 53154-4563
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Country | US
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Telephone | 414-570-3590
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 735044
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City | CHICAGO
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State | IL
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Zip | 60673-5044
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Country | US
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Telephone | 800-326-2250
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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 | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | 38588-020
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207RA0201X
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Taxonomy Name | Allergy & Immunology (Internal Medicine) Physician
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License Number | 38588
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License Number State | WI
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