Basic Information
| Provider Information | |||||||||
| NPI: | 1659049948 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | PFEILSTIFTER | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3301 W FOREST HOME AVE | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532152843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2623291000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 975 PORT WASHINGTON RD | ||||||||
| Address2: | |||||||||
| City: | GRAFTON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530249201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2623291000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2021 | ||||||||
| LastUpdateDate: | 12/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 5611 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.