MEDICARE: MEDICAL MANAGEMENT ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245406982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL MANAGEMENT ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	2727 W CLEVELAND AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-2956
Country	:	US
Telephone Number	:	414-384-9880
Fax Number	:	414-384-0134

Provider Business Practice Location Address
First Line	:	2727 W CLEVELAND AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-2956
Country	:	US
Telephone Number	:	414-384-9880
Fax Number	:	414-384-0134

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RANDALL T WESTLEY
Credential	:
Telephone Number	:	414-384-9880

Provider Enumeration Date	:	05/02/2008
Last Update Date	:	10/13/2016

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