Basic Information
| Provider Information | |||||||||
| NPI: | 1699714832 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLDEFER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8832 N PORT WASHINGTON RD | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532171628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143516666 | ||||||||
| FaxNumber: | 4143516999 | ||||||||
| Practice Location | |||||||||
| Address1: | 8832 N PORT WASHINGTON RD | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532171628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143516666 | ||||||||
| FaxNumber: | 4143516999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZE0600X | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic |
No ID Information.