MEDICARE: ANGELA MARIE PICKART MS

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	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1528045911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MARIE PICKART MS

Provider Business Mailing Address
First Line	:	2372 N 84TH ST
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-1902
Country	:	US
Telephone Number	:	414-302-4656
Fax Number	:

Provider Business Practice Location Address
First Line	:	9000 W WISCONSIN AVE
Second Line	:	MS 716
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-3518
Country	:	US
Telephone Number	:	414-266-2910
Fax Number	:

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

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	07/08/2007

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