Basic Information
| Provider Information | |||||||||
| NPI: | 1699137745 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ST. CLAIR | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | CAITLIN | ||||||||
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| Credential: | D. O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9895 W REMINGTON PL | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801286734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039482676 | ||||||||
| FaxNumber: | 3039049151 | ||||||||
| Practice Location | |||||||||
| Address1: | 2801 W KINNICKINNIC RIVER PKWY STE 250 | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532153678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4146497909 | ||||||||
| FaxNumber: | 4146493361 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2016 | ||||||||
| LastUpdateDate: | 08/28/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | DR.0062996 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.