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General NPI Number Information
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NPI Number | 1881694743
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Entity Type | Individual
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Provider Name | ROBERT W NINNEMAN MD
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Gender | Male
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Dates
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Enumeration Date | 07/21/2005
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 19725 DAVIDSON RD
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City | BROOKFIELD
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State | WI
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Zip | 53045
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Country | US
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Telephone | 414-852-4845
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Fax | 414-649-3551
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Provider Business Mailing Address
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Address Line | 19725 DAVIDSON RD
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City | BROOKFIELD
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State | WI
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Zip | 53045
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Country | US
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Telephone | 414-852-4845
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Fax | 414-649-3551
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 22477
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 22477020
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License Number State | WI
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