MEDICARE: BADGER MEDICAL GROUP S.C.

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	261QU0200X	Urgent Care Clinic/Center	42642-020	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	:	1902215189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BADGER MEDICAL GROUP S.C.

Provider Business Mailing Address
First Line	:	1700 CORAL DR
Second Line	:
City	:	WAUKESHA
State	:	WI
Zip	:	53186-1483
Country	:	US
Telephone Number	:	262-232-6200
Fax Number	:	262-232-6201

Provider Business Practice Location Address
First Line	:	1700 CORAL DR
Second Line	:
City	:	WAUKESHA
State	:	WI
Zip	:	53186-1483
Country	:	US
Telephone Number	:	262-232-6200
Fax Number	:	262-232-6201

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. RYAN D HOLZMACHER
Credential	:	M.D.
Telephone Number	:	414-202-1724

Provider Enumeration Date	:	08/12/2014
Last Update Date	:	09/02/2014

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