Provider Demographics
NPI:1669655577
Name:HALL, JUDITH KATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:KATHERINE
Last Name:HALL
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 1:611 W NATIONAL AVE
Mailing Address - Street 2:WALKERS POINT COMMUNITY CLINIC
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:414-672-7012
Practice Address - Street 1:611 W NATIONAL AVE
Practice Address - Street 2:WALKERS POINT COMMUNITY CLINIC
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204
Practice Address - Country:US
Practice Address - Phone:414-442-4763
Practice Address - Fax:414-672-7012
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24108207Q00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D33994Medicare UPIN