Basic Information
| Provider Information | |||||||||
| NPI: | 1922127836 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIFETIME OB GYN, LTD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17280 W NORTH AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BROOKFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530454366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2627548000 | ||||||||
| FaxNumber: | 2627548008 | ||||||||
| Practice Location | |||||||||
| Address1: | 3070 N 51ST ST | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532101645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2627548000 | ||||||||
| FaxNumber: | 2627548008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | METOFF | ||||||||
| AuthorizedOfficialFirstName: | JOANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2627548000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.