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NPI Code Detail

MEDICARE: ETHER THARPE

MEDICARE: ETHER THARPE
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
1251B00000XCase Management Agency

General Provider Information

NPI Number : 1780398891
Entity Type Code : Individual
Provider Name (Legal Business Name) : ETHER THARPE
Provider Business Mailing Address
First Line : 2740 N 6TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53212-2332
Country : US
Telephone Number : 414-484-1968
Fax Number :
Provider Business Practice Location Address
First Line : 2740 N 6TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53212-2332
Country : US
Telephone Number : 414-484-1968
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2023
Last Update Date : 01/12/2023

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Directions to “ ETHER THARPE ” Practice Location

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