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NPI Code Detail

MEDICARE: FROEDTERT & THE MEDICAL COLLEGE OF WISCONSIN COMMUNITY PHYSICIANS INC

MEDICARE: FROEDTERT & THE MEDICAL COLLEGE OF WISCONSIN COMMUNITY PHYSICIANS INC
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
1332B00000XDurable Medical Equipment & Medical Supplies

General Provider Information

NPI Number : 1457799975
Entity Type Code : Organization
Provider Name (Legal Business Name) : FROEDTERT & THE MEDICAL COLLEGE OF WISCONSIN COMMUNITY PHYSICIANS INC
Provider Business Mailing Address
First Line : WOODLAND PRIME 400 SUITE 103
Second Line : N74 W12501 LEATHERWOOD COURT
City : MENOMONEE FALLS
State : WI
Zip : 53051-4490
Country : US
Telephone Number : 414-777-0417
Fax Number : 414-777-0096
Provider Business Practice Location Address
First Line : W225N16711 CEDAR PARK CT
Second Line :
City : JACKSON
State : WI
Zip : 53037-9222
Country : US
Telephone Number : 262-677-1101
Fax Number : 262-677-0121
Authorized Official
Title or Position : PRESIDENT & CEO
Name : AMIR ABBAS GHAFERI
Credential : MD
Telephone Number : 734-660-4939
Provider Enumeration Date : 06/06/2013
Last Update Date : 05/31/2024

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Directions to “FROEDTERT & THE MEDICAL COLLEGE OF WISCONSIN COMMUNITY PHYSICIANS INC ” Practice Location

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