Provider Demographics
NPI:1871540518
Name:AMOS, LOUELLA B (MD)
Entity type:Individual
Prefix:MS
First Name:LOUELLA
Middle Name:B
Last Name:AMOS
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Gender:F
Credentials:MD
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Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC PULMONARY DISEASE
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-6730
Mailing Address - Fax:414-266-6742
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC PULMONARY DISEASE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-6730
Practice Address - Fax:414-266-6742
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2012-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI475472080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1871540518Medicaid
WI34838500Medicaid
WI1871540518Medicaid