Healthcare Provider Details

I. General information

NPI: 1790866457
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

7950 N PORT WASHINGTON RD
FOX POINT WI
53217-3133
US

IV. Provider business mailing address

7950 N PORT WASHINGTON RD
FOX POINT WI
53217-3133
US

V. Phone/Fax

Practice location:
  • Phone: 414-540-5980
  • Fax: 414-540-2416
Mailing address:
  • Phone: 414-540-5980
  • Fax: 414-540-2416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

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