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NPI Code Detail

MEDICARE: DR. NOAH JEANNETTE DO

MEDICARE: DR. NOAH JEANNETTE DO
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
12084P0800XPsychiatry Physician67385WI
22084P0800XPsychiatry Physician0S9252FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265542948
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NOAH JEANNETTE DO
Provider Business Mailing Address
First Line : 3301 W FOREST HOME AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53215-2843
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1525 N 12TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53205-2591
Country : US
Telephone Number : 414-966-3030
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 09/23/2022

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