Doctor Name: | DR. MARY PATRICIA ELDRIDGE |
NPI Number: | 1063673903 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | 54685-20 |
Business Practice Address: | 1400 75th St Suite #5 Kenosha, WI - 531431544 |
Business Phone Number: | 2626561911 |
Business Fax Number: | 8883168458 |
Mailing Address: | 1400 75th St, Suite #5 KENOSHA |
State: | WI |
Postal Code: | 531431544 |
Phone Number: | 2626561911 |
Fax Number: | 8883168458 |
NPI Enumeration Date: | 06/23/2008 |
NPI Last Update Date: | 09/19/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 54685-20 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |