Active NPI
Andre D Harwell, LAT
- Athletic Trainer
- Milwaukee, WI
National Provider Identifier
1902848252
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 722-039
- Practice address
- 625 E Saint Paul Ave
Milwaukee, WI 53202-5907 - Phone
- (414) 223-2727
- NPI assigned
- Jun 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 722-039 | WI | Primary |
Addresses
Primary practice location
625 E Saint Paul Ave
Milwaukee, WI 53202-5907
Mailing address
11931 W Mill Rd
Milwaukee, WI 53225-1023
Phone (414) 760-0517
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 722-039 | WI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190764800000",
"number": "1902848252",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11931 W MILL RD",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532251023",
"telephone_number": "414-760-0517"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "625 E SAINT PAUL AVE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532025907",
"telephone_number": "414-223-2727"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARWELL",
"first_name": "ANDRE",
"middle_name": "D",
"name_prefix": "Mr.",
"credential": "LAT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-12",
"last_updated": "2007-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WI",
"license": "722-039",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.