=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619381480
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN JAROSZ D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2014
-----------------------------------------------------
Last Update Date | 11/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9200 W WISCONSIN AVE
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53226-3522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-805-0805
-----------------------------------------------------
Fax | 414-955-0122
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9200 W WISCONSIN AVE
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53226-3522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-805-0805
-----------------------------------------------------
Fax | 414-955-0122
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 70869
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | 5101021031
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | 70869
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------