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General NPI Number Information
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NPI Number | 1902078801
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Entity Type | Individual
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Provider Name | JOSEPH A LOCKE D.O
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Gender | Male
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Dates
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Enumeration Date | 03/31/2008
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Last Update Date | 09/24/2019
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Provider Practice Location Address
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Address Line | 2500 N MAYFAIR RD STE 630
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City | WAUWATOSA
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State | WI
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Zip | 53226-1428
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Country | US
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Telephone | 262-202-8312
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Fax | 414-973-2870
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Provider Business Mailing Address
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Address Line | PO BOX 639
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City | THIENSVILLE
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State | WI
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Zip | 53092-0639
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Country | US
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Telephone | 262-202-8312
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Fax | 414-973-2870
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 53594-21
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License Number State | WA
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