Provider Demographics
NPI:1922127836
Name:LIFETIME OB GYN, LTD.
Entity Type:Organization
Organization Name:LIFETIME OB GYN, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:METOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-754-8000
Mailing Address - Street 1:17280 W NORTH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-4366
Mailing Address - Country:US
Mailing Address - Phone:262-754-8000
Mailing Address - Fax:262-754-8008
Practice Address - Street 1:3070 N 51ST ST
Practice Address - Street 2:SUITE 305
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1645
Practice Address - Country:US
Practice Address - Phone:262-754-8000
Practice Address - Fax:262-754-8008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1194Medicare ID - Type Unspecified