Provider Demographics
NPI:1780768531
Name:CONNELLY, JENNIFER MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARIE
Last Name:CONNELLY
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Gender:F
Credentials:MD
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DEPT OF NEUROLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-5254
Mailing Address - Fax:414-805-5252
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DEPT OF NEUROLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-5254
Practice Address - Fax:414-805-5252
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2012-11-01
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Provider Licenses
StateLicense IDTaxonomies
WI475052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1780768531Medicaid
WI680860618Medicare PIN
WI116073601Medicare PIN