Provider Demographics
NPI:1558366450
Name:ALDRICH, PERI LYNNE (MD)
Entity Type:Individual
Prefix:
First Name:PERI
Middle Name:LYNNE
Last Name:ALDRICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4468 COUNTRY AIRE CT
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:WI
Mailing Address - Zip Code:54155
Mailing Address - Country:US
Mailing Address - Phone:920-865-4151
Mailing Address - Fax:
Practice Address - Street 1:1077 SUNLITE DR
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:WI
Practice Address - Zip Code:54155-9191
Practice Address - Country:US
Practice Address - Phone:920-434-9012
Practice Address - Fax:920-434-9015
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21592207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIB84648Medicare UPIN