Healthcare Provider Details

I. General information

NPI: 1528976610
Provider Name (Legal Business Name): WISCONSIN PROFESSIONAL MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 S EXECUTIVE DR STE 350
BROOKFIELD WI
53005-4214
US

IV. Provider business mailing address

304 WAINWRIGHT DR STE 120
NORTHBROOK IL
60062-1919
US

V. Phone/Fax

Practice location:
  • Phone: 262-207-4477
  • Fax:
Mailing address:
  • Phone: 847-257-1244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER MORRISON
Title or Position: OWNER
Credential: MD
Phone: 727-644-3038