Basic Information
Provider Information
NPI: 1073788394
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PITNER
FirstName: NATHANIEL
MiddleName: DOUGLAS
NamePrefix: DR.
NameSuffix:  
Credential: M.D., PH.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9200 W. WISCONSIN AVENUE
Address2: DEPARTMENT OF ANESTHESIOLOGY
City: MILWAUKEE
State: WI
PostalCode: 53226
CountryCode: US
TelephoneNumber: 4148058700
FaxNumber: 4142591522
Practice Location
Address1: 9200 W. WISCONSIN AVENUE
Address2: DEPARTMENT OF ANESTHESIOLOGY
City: MILWAUKEE
State: WI
PostalCode: 53226
CountryCode: US
TelephoneNumber: 4148058700
FaxNumber: 4142591522
Other Information
ProviderEnumerationDate: 04/28/2008
LastUpdateDate: 07/08/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X53414WIY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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