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NPI Code Detail

MEDICARE: JAMES JOSEPH ANDRESEN

MEDICARE: JAMES JOSEPH ANDRESEN
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1518597863
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES JOSEPH ANDRESEN
Provider Business Mailing Address
First Line : 5434 CHARLES ST
Second Line :
City : RACINE
State : WI
Zip : 53402-2122
Country : US
Telephone Number : 414-731-7769
Fax Number :
Provider Business Practice Location Address
First Line : 3409 N DOWNER AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53211-2934
Country : US
Telephone Number : 414-731-7769
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2020
Last Update Date : 01/24/2020

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