Healthcare Provider Details

I. General information

NPI: 1831173699
Provider Name (Legal Business Name): FACULTY PHYSICIANS OF INTERNAL MEDICINE, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W KINNICKINNIC RIVER PKWY SUITE 730
MILWAUKEE WI
53215-3669
US

IV. Provider business mailing address

2801 W KINNICKINNIC RIVER PKWY SUITE 730
MILWAUKEE WI
53215-3669
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-7202
  • Fax: 414-649-5158
Mailing address:
  • Phone: 414-649-7202
  • Fax: 414-649-5158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateWI

VIII. Authorized Official

Name: MRS. COLLEEN M NICHOLS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 414-649-7202