Organization Name: | LORELLE M MANION, MD, SC |
NPI Number: | 1023225042 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LORELLE MICHELLE MANION (PRESIDENT) |
Mailing Address: | 1305 N Barker Rd Suite 1 Brookfield |
State: | WI US |
Postal Code: | 530455230 |
Phone Number: | 2627843200 |
Fax Number: | 2627848198 |
NPI Enumeration Date: | 05/17/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 35609 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |