Healthcare Provider Details

I. General information

NPI: 1962501593
Provider Name (Legal Business Name): V G LUBSEY, MD, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 W VILLARD AVE
MILWAUKEE WI
53218-4345
US

IV. Provider business mailing address

5300 W VILLARD AVE
MILWAUKEE WI
53218-4345
US

V. Phone/Fax

Practice location:
  • Phone: 414-438-6666
  • Fax: 414-438-6667
Mailing address:
  • Phone: 414-438-6666
  • Fax: 414-438-6667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22021
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number24166
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number52774
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number46489-20
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number43796
License Number StateWI
# 6
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number21373
License Number StateWI
# 7
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number21373
License Number StateWI
# 8
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3666-030
License Number StateWI
# 9
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3471-033
License Number StateWI
# 10
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number81498-030
License Number StateWI
# 11
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4599-033
License Number StateWI
# 12
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4763-33
License Number StateWI

VIII. Authorized Official

Name: MR. KRIS L KLEINBECK
Title or Position: ADMINISTRATOR
Credential:
Phone: 414-438-6666