Basic Information
| Provider Information | |||||||||
| NPI: | 1083680847 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PENNEY | ||||||||
| FirstName: | ALBERT | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17280 W NORTH AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BROOKFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530454366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2627548000 | ||||||||
| FaxNumber: | 2627548008 | ||||||||
| Practice Location | |||||||||
| Address1: | 17280 W NORTH AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BROOKFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530454366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2627548000 | ||||||||
| FaxNumber: | 2627548008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2006 | ||||||||
| LastUpdateDate: | 06/10/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 45953 | WI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.