Allen-Gryzwa, Shannon Pheadra

Allen-Gryzwa, Shannon Pheadra is an individual health care provider with primary practice located at Premise Healthcare Miller Health & Fitness 4400 W. State St., Milwaukee WI 53208. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Allen-Gryzwa, Shannon Pheadra can be contacted via phone (262) 928-1900.

Contact Information

Primary practice address
Premise Healthcare Miller Health & Fitness 4400 W. State St. Milwaukee WI 53208
Phone: (262) 928-1900
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 40073 Wisconsin

Profile Details

NPI number 1306819479
LBN Legal business name Allen-Gryzwa, Shannon Pheadra
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 9th, 2006
Last updated Feb 16th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306819479 NPPES
Wisconsin MEDICAID 32639500

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