Healthcare Provider Details

I. General information

NPI: 1245470699
Provider Name (Legal Business Name): MIDWEST AREA PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 12/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 N 12TH ST
MILWAUKEE WI
53233-1305
US

IV. Provider business mailing address

945 N 12TH ST
MILWAUKEE WI
53233-1305
US

V. Phone/Fax

Practice location:
  • Phone: 414-219-6734
  • Fax:
Mailing address:
  • Phone: 414-219-6734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LYNDA EVANS
Title or Position: DIRECTOR PHYSICIAN ACCOUNTS
Credential:
Phone: 414-389-2127