Healthcare Provider Details

I. General information

NPI: 1104938331
Provider Name (Legal Business Name): PULMONARY & CRITICAL CARE ASSOCIATES S C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 S LAKE DR
CUDAHY WI
53110-3171
US

IV. Provider business mailing address

5900 S LAKE DR LOWR LEVEL
CUDAHY WI
53110-3171
US

V. Phone/Fax

Practice location:
  • Phone: 414-744-4000
  • Fax: 414-489-4022
Mailing address:
  • Phone: 414-744-4000
  • Fax: 414-489-4022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGELA THERESA WALTER
Title or Position: OFFICE MANAGER
Credential:
Phone: 414-744-4000