Provider Demographics
NPI:1043287717
Name:MOLLOY, ROBERT MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHAEL
Last Name:MOLLOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3033 S 27TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3600
Mailing Address - Country:US
Mailing Address - Phone:414-908-6615
Mailing Address - Fax:414-385-2980
Practice Address - Street 1:1033 N MAYFAIR RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3442
Practice Address - Country:US
Practice Address - Phone:414-454-0600
Practice Address - Fax:414-454-0971
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2007-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI32598207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32307800Medicaid
WI32307800Medicaid