Healthcare Provider Details

I. General information

NPI: 1871674408
Provider Name (Legal Business Name): WHEATON FRANCISCAN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7961 N 76TH ST
MILWAUKEE WI
53223-3947
US

IV. Provider business mailing address

7961 N 76TH ST
MILWAUKEE WI
53223-3947
US

V. Phone/Fax

Practice location:
  • Phone: 414-462-7500
  • Fax: 414-462-3037
Mailing address:
  • Phone: 414-462-7500
  • Fax: 414-462-3037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LARRY WADE
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 414-465-3000