Provider Demographics
NPI:1942347737
Name:ZELL, ANTOINETTE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTOINETTE
Middle Name:MARIE
Last Name:ZELL
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 1:2405 NORTHWESTERN AVE
Mailing Address - Street 2:SUITE #115
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53404-2503
Mailing Address - Country:US
Mailing Address - Phone:262-637-9438
Mailing Address - Fax:262-637-8947
Practice Address - Street 1:2405 NORTHWESTERN AVE
Practice Address - Street 2:SUITE #115
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53404-2503
Practice Address - Country:US
Practice Address - Phone:262-637-9438
Practice Address - Fax:262-637-8947
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24289207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30799800Medicaid
WI21288200Medicare ID - Type UnspecifiedSWIFTCARE LOCATION
WI30799800Medicaid