Healthcare Provider Details

I. General information

NPI: 1073694618
Provider Name (Legal Business Name): WHEATON FRANCISCAN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13950 W CAPITOL DR
BROOKFIELD WI
53005-2441
US

IV. Provider business mailing address

13950 W CAPITOL DR
BROOKFIELD WI
53005-2441
US

V. Phone/Fax

Practice location:
  • Phone: 414-302-5400
  • Fax: 414-302-5495
Mailing address:
  • Phone: 414-302-5400
  • Fax: 414-302-5495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: LARRY WADE
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 414-465-3000