Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
Jan 16, 2009
License(s)
2013034091 (MO), T4301 (TX), 65778 (WI)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1575 N RIVERCENTER DR | Milwaukee, WI 53212-3978 | 414-283-8444 |
| MAILING | PO BOX 735044 | Chicago, IL 60673-5044 | 800-326-2250 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.