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General NPI Number Information
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NPI Number | 1902694037
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Entity Type | Organization
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Legal Business Name | TRICHO MEDICAL LLC
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Dates
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Enumeration Date | 04/29/2025
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 11607 W BLUEMOUND RD STE 101
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City | WAUWATOSA
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State | WI
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Zip | 53226-3960
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Country | US
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Telephone | 414-775-6257
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Fax |
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Provider Business Mailing Address
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Address Line | 6650 W STATE ST # 230
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City | MILWAUKEE
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State | WI
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Zip | 53213-2827
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Country | US
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Telephone | 414-467-8212
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHARLETTE JOHNSON
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Credential | RN
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Telephone | 414-775-6257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number |
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License Number State |
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