| Rachael Weiderhold D.o. Inc | |
|
9004 W Lincoln Ave Suite 101 West Allis WI 53227-2452 | |
| (414) 545-5542 | |
| (414) 545-5548 |
| Full Name | Rachael Weiderhold D.o. Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 9004 W Lincoln Ave, West Allis, Wisconsin |
| Authorized Official Name and Position | Rachael Lynn Gates (OWNER) |
| Authorized Official Contact | 4145455542 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rachael Weiderhold D.o. Inc 9004 W Lincoln Ave Suite 101 West Allis WI 53227-2452 Ph: (414) 545-5542 | Rachael Weiderhold D.o. Inc 9004 W Lincoln Ave Suite 101 West Allis WI 53227-2452 Ph: (414) 545-5542 |
| NPI Number | 1215942867 |
|---|---|
| Provider Enumeration Date | 07/30/2006 |
| Last Update Date | 11/04/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215942867 | NPI | - | NPPES |
| 30057700 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 32395 (Wisconsin) | Primary |
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