Healthcare Provider Details

I. General information

NPI: 1912757444
Provider Name (Legal Business Name): MILWAUKEE EP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 W LAYTON AVE
MILWAUKEE WI
53221-1500
US

IV. Provider business mailing address

6030 S RICE AVE STE C
HOUSTON TX
77081-2944
US

V. Phone/Fax

Practice location:
  • Phone: 713-660-0555
  • Fax:
Mailing address:
  • Phone: 713-660-0557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: TOM VO
Title or Position: CEO
Credential:
Phone: 713-660-0557