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General NPI Number Information
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NPI Number | 1588619134
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Entity Type | Organization
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Legal Business Name | MALA THENAPPAN, MD
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3070 N 51ST ST SUITE 100
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City | MILWAUKEE
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State | WI
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Zip | 53210-1645
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Country | US
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Telephone | 414-875-9950
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Fax | 414-447-2575
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Provider Business Mailing Address
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Address Line | 3070 N 51ST ST SUITE 100
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City | MILWAUKEE
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State | WI
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Zip | 53210-1645
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Country | US
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Telephone | 414-875-9950
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Fax | 414-447-2575
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Authorized Official
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Title or Position | PRESIDENT
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Name | MALA THENAPPAN
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Credential | MD
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Telephone | 414-875-9950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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