MEDICARE: CARDIOVASCULAR ASSOCIATES OF WISCONSIN, LLP

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	207RC0000X	Cardiovascular Disease Physician		WI

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	:	1841286291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOVASCULAR ASSOCIATES OF WISCONSIN, LLP

Provider Business Mailing Address
First Line	:	2801 W KINNICKINNIC RIVER PKWY #840
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53214-3678
Country	:	US
Telephone Number	:	414-649-3530
Fax Number	:	414-649-3551

Provider Business Practice Location Address
First Line	:	2801 W KINNICKINNIC RIVER PKWY #840
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53214-3678
Country	:	US
Telephone Number	:	414-649-3530
Fax Number	:	414-649-3551

Authorized Official
Title or Position	:	BILLING LEAD
Name	:	MS. WANDA KUSMIEREK
Credential	:
Telephone Number	:	414-219-7845

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	01/22/2008

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