Provider Demographics
NPI:1053408294
Name:DONNA PITTER MD
Entity type:Organization
Organization Name:DONNA PITTER MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:E
Authorized Official - Last Name:PITTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-442-7900
Mailing Address - Street 1:7 CLYDE RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-5049
Mailing Address - Country:US
Mailing Address - Phone:866-266-6822
Mailing Address - Fax:
Practice Address - Street 1:6001 W CENTER ST
Practice Address - Street 2:#200
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-2154
Practice Address - Country:US
Practice Address - Phone:414-442-7900
Practice Address - Fax:414-442-8156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30619700Medicaid