MEDICARE: ROBERT AGNEW JR. EMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	146N00000X	Basic Emergency Medical Technician	70117917	WI

General Provider Information

NPI Number	:	1073363834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT AGNEW JR. EMT

Provider Business Mailing Address
First Line	:	2828 N 12TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53206-2615
Country	:	US
Telephone Number	:	305-607-5623
Fax Number	:

Provider Business Practice Location Address
First Line	:	3440 N 54TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2802
Country	:	US
Telephone Number	:	305-607-5623
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2024
Last Update Date	:	03/25/2024

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