| Theresa Pardoe D.o. | |
|
9305 W National Ave West Allis WI 53227-1541 | |
| (414) 545-1120 | |
| (414) 545-2505 |
| Full Name | Theresa Pardoe D.o. |
|---|---|
| Speciality | Family Medicine |
| Location | 9305 W National Ave, West Allis, Wisconsin |
| Authorized Official Name and Position | Theresa Marie Pardoe (OWNER) |
| Authorized Official Contact | 4145451120 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Theresa Pardoe D.o. 9305 W National Ave West Allis WI 53227-1541 Ph: (414) 545-1120 | Theresa Pardoe D.o. 9305 W National Ave West Allis WI 53227-1541 Ph: (414) 545-1120 |
| NPI Number | 1083635189 |
|---|---|
| Provider Enumeration Date | 07/22/2006 |
| Last Update Date | 07/22/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083635189 | NPI | - | NPPES |
| 31462700 | Medicaid | WI | |
| 479701014009 | Other | BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 29660 (Wisconsin) | Primary |
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