Healthcare Provider Details

I. General information

NPI: 1124804026
Provider Name (Legal Business Name): WISCONSIN CENTER FOR INFUSION, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3870 S 108TH ST STE B
GREENFIELD WI
53228-1308
US

IV. Provider business mailing address

1726 COLE BLVD STE 250
LAKEWOOD CO
80401-3262
US

V. Phone/Fax

Practice location:
  • Phone: 414-460-3195
  • Fax:
Mailing address:
  • Phone: 855-478-1528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JASON RAASCH
Title or Position: OWNER
Credential: MD
Phone: 414-239-6248