Provider Demographics
NPI:1104050954
Name:O'TOOL, ERIN MATTHEW (MD)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:MATTHEW
Last Name:O'TOOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8825 S HOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-3760
Mailing Address - Country:US
Mailing Address - Phone:414-647-3920
Mailing Address - Fax:414-465-4730
Practice Address - Street 1:8825 S HOWELL AVE
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-3760
Practice Address - Country:US
Practice Address - Phone:414-647-3920
Practice Address - Fax:414-465-4730
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI55833207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI738400914Medicare PIN