Provider Demographics
NPI:1912077686
Name:CARLSON, ALISA ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALISA
Middle Name:ANNE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:MS 958
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-7615
Mailing Address - Fax:414-266-6238
Practice Address - Street 1:12635 W. BLUEMOUND ROAD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-8004
Practice Address - Country:US
Practice Address - Phone:414-258-0606
Practice Address - Fax:414-258-1953
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2016-06-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI51476208000000X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1912077686Medicaid
WI68086 1036Medicare PIN
WI73601 2261Medicare PIN