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General NPI Number Information
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NPI Number | 1821318023
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Entity Type | Organization
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Legal Business Name | SHALOM HEALTH CENTER, SC
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Dates
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Enumeration Date | 06/10/2010
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Last Update Date | 06/10/2010
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Provider Practice Location Address
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Address Line | 6001 W CENTER ST SUITE 200
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City | MILWAUKEE
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State | WI
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Zip | 53210-2154
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Country | US
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Telephone | 414-442-7900
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Fax | 414-442-8156
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Provider Business Mailing Address
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Address Line | 6001 W CENTER ST SUITE 200
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City | MILWAUKEE
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State | WI
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Zip | 53210-2154
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Country | US
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Telephone | 414-442-7900
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Fax | 414-442-8156
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Authorized Official
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Title or Position | OWNER
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Name | DR. DONNA E PITTER
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Credential | M.D.
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Telephone | 414-442-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 28453
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License Number State | WI
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