Healthcare Provider Details

I. General information

NPI: 1073832218
Provider Name (Legal Business Name): COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 W RIVER WOODS PKWY
GLENDALE WI
53212-1080
US

IV. Provider business mailing address

4425 N PORT WASHINGTON RD
GLENDALE WI
53212-1082
US

V. Phone/Fax

Practice location:
  • Phone: 414-326-1800
  • Fax:
Mailing address:
  • Phone: 414-291-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL MCCULLOUGH
Title or Position: CFO
Credential:
Phone: 414-465-3736