Healthcare Provider Details

I. General information

NPI: 1003828054
Provider Name (Legal Business Name): CARDIOGRAPHICS PHYSICIANS ST. MARY'S OZAUKEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13111 N PORT WASHINGTON RD
MEQUON WI
53097-2416
US

IV. Provider business mailing address

11716 W GREENFIELD AVE
WEST ALLIS WI
53214-2156
US

V. Phone/Fax

Practice location:
  • Phone: 262-243-7300
  • Fax:
Mailing address:
  • Phone: 414-778-3860
  • Fax: 414-778-3886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT HUXLEY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 262-243-7300