Basic Information
| Provider Information | |||||||||
| NPI: | 1902341571 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOLEY | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10625 W. NORTH AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532262315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4148775350 | ||||||||
| FaxNumber: | 4148775360 | ||||||||
| Practice Location | |||||||||
| Address1: | 10625 W NORTH AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532262315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4148775350 | ||||||||
| FaxNumber: | 4148775360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 085729 | IA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 4154-23 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.