Provider Demographics
NPI:1174503841
Name:MOSS, SHERYL L (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERYL
Middle Name:L
Last Name:MOSS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6400 INDUSTRIAL LOOP
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-2452
Mailing Address - Country:US
Mailing Address - Phone:414-423-4100
Mailing Address - Fax:414-423-4134
Practice Address - Street 1:10625 W NORTH AVE
Practice Address - Street 2:SUITE 222
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2315
Practice Address - Country:US
Practice Address - Phone:414-453-7173
Practice Address - Fax:414-453-4653
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI23826-020208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30521800Medicaid
WIB55236Medicare UPIN