Provider Demographics
NPI:1376083402
Name:FARRELL, DENNIS (CP)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:
Last Name:FARRELL
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 N MAYFAIR RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3431
Mailing Address - Country:US
Mailing Address - Phone:414-259-1950
Mailing Address - Fax:414-259-1533
Practice Address - Street 1:1011 N MAYFAIR RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3431
Practice Address - Country:US
Practice Address - Phone:414-259-1950
Practice Address - Fax:414-259-1533
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist