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General NPI Number Information
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NPI Number | 1891769865
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Entity Type | Individual
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Provider Name | VICTORIA J. MONDLOCH M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/15/2006
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Last Update Date | 01/17/2013
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Provider Practice Location Address
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Address Line | 20800 SWENSON DR SUITE 425
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City | WAUKESHA
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State | WI
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Zip | 53186-2058
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Country | US
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Telephone | 262-524-9116
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Fax | 262-754-4943
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Provider Business Mailing Address
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Address Line | 20800 SWENSON DR SUITE 425
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City | WAUKESHA
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State | WI
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Zip | 53186-2058
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Country | US
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Telephone | 262-524-9116
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Fax | 262-754-4943
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 26004
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License Number State | WI
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