NPI 1174812499

Annaliese Marie Koller Shumate, DO

Practitioner General Practice Physician Wauwatosa, WI

Practice location

Address: 1155 N Mayfair Rd 3rd Floor, Department of Psychiatry, Wauwatosa, WI 53226-3462
Phone: (414) 955-8990

Registered specialties

General Practice Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208D00000X Licence 60433-21 (WI)

Other General Practice providers in Wisconsin →

Registry record

NPI: 1174812499
Entity type: Individual
Sex (as registered): Female
NPI issued: 7 Apr 2011
Record last updated: 17 Oct 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.