Healthcare Provider Details

I. General information

NPI: 1861506255
Provider Name (Legal Business Name): KEWASKUM FIRE DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 FOND DU LAC AVE
KEWASKUM WI
53040
US

IV. Provider business mailing address

PO BOX 72140
CEDARBURG WI
53012-7340
US

V. Phone/Fax

Practice location:
  • Phone: 262-626-2842
  • Fax:
Mailing address:
  • Phone: 262-375-9610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID SULIK
Title or Position: BILLING MANAGER
Credential:
Phone: 262-375-9610