Basic Information
| Provider Information | |||||||||
| NPI: | 1790001121 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEISTER | ||||||||
| FirstName: | CARLA | ||||||||
| MiddleName: | JEAN | ||||||||
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| OtherLastName: | IHM | ||||||||
| OtherFirstName: | CARLA | ||||||||
| OtherMiddleName: | JEAN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 999 N 92ND ST | ||||||||
| Address2: | MED-PEDS RESIDENCY PROGRAM, SUITE C430 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532264875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143377030 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1905 N CALHOUN RD | ||||||||
| Address2: | |||||||||
| City: | BROOKFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530055036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2627548000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2010 | ||||||||
| LastUpdateDate: | 09/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 57146 | WI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 57146 | WI | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.