Healthcare Provider Details

I. General information

NPI: 1962129411
Provider Name (Legal Business Name): WISCONSIN CARDIOLOGY ASSOCIATES, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11725 N PORT WASHINGTON RD STE 250
MEQUON WI
53092-3486
US

IV. Provider business mailing address

6400 INDUSTRIAL LOOP
GREENDALE WI
53129-2452
US

V. Phone/Fax

Practice location:
  • Phone: 414-207-4333
  • Fax:
Mailing address:
  • Phone: 414-858-4106
  • Fax:

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: JOSHUA LIBERMAN
Title or Position: OWNER
Credential: MD
Phone: 414-207-4333