Healthcare Provider Details

I. General information

NPI: 1407857188
Provider Name (Legal Business Name): WEST SUBURBAN CTR FOR ARTHRITIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N BARKER RD 110
BROOKFIELD WI
53045-5929
US

IV. Provider business mailing address

601 N BARKER RD 110
BROOKFIELD WI
53045-5929
US

V. Phone/Fax

Practice location:
  • Phone: 262-785-0777
  • Fax: 262-785-0610
Mailing address:
  • Phone: 262-785-0777
  • Fax: 262-785-0610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. AMY HEHN
Title or Position: OFFICE MANAGER
Credential:
Phone: 262-785-1964