Provider Demographics
NPI:1790001121
Name:MEISTER, CARLA JEAN
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:JEAN
Last Name:MEISTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:JEAN
Other - Last Name:IHM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:999 N 92ND ST
Mailing Address - Street 2:MED-PEDS RESIDENCY PROGRAM, SUITE C430
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4875
Mailing Address - Country:US
Mailing Address - Phone:414-337-7030
Mailing Address - Fax:
Practice Address - Street 1:1905 N CALHOUN RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-5036
Practice Address - Country:US
Practice Address - Phone:262-754-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI57146207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine