Unknown Individual – Family Medicine Physician, NPI 1063459402
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
8520, West Oklahoma Avenue, West Allis, Milwaukee County, Wisconsin, 53227, United States
WEST ALLIS, WI 532274604
Phone: (414) 607-4291
Fax: (414) 607-4530
Type: Location
9604, North Lake Drive, Bayside, Ozaukee County, Wisconsin, 53092, United States
MILWAUKEE, WI 532176100
Phone: (414) 352-7202
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 53227)
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