Provider Demographics
NPI:1982782405
Name:ROWLETT, RANDALL R (MD)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:R
Last Name:ROWLETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8989 N PORT WASHINGTON RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-1633
Mailing Address - Country:US
Mailing Address - Phone:414-352-3336
Mailing Address - Fax:414-352-3928
Practice Address - Street 1:8989 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE 220
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53217-1633
Practice Address - Country:US
Practice Address - Phone:414-352-3336
Practice Address - Fax:414-352-3928
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI312382084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry