Healthcare Provider Details

I. General information

NPI: 1033039466
Provider Name (Legal Business Name): MOOV-WISCONSIN S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17110 W GREENFIELD AVE STE 6
BROOKFIELD WI
53005-6947
US

IV. Provider business mailing address

2100 POWELL ST STE 400
EMERYVILLE CA
94608-1872
US

V. Phone/Fax

Practice location:
  • Phone: 262-277-1018
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID ANDREW BIRDSALL
Title or Position: CHIEF OPERATIONS OFFICER
Credential: MD
Phone: 510-851-7552