Healthcare Provider Details

I. General information

NPI: 1619022274
Provider Name (Legal Business Name): PERINATAL CENTER OF WISCONSIN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3353 N DR MARTIN LUTHER KING DR
MILWAUKEE WI
53212-1455
US

IV. Provider business mailing address

3353 N DR MARTIN LUTHER KING DR
MILWAUKEE WI
53212-1455
US

V. Phone/Fax

Practice location:
  • Phone: 414-372-1000
  • Fax: 414-372-6000
Mailing address:
  • Phone: 414-372-1000
  • Fax: 414-372-6000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: JANINE JAMES
Title or Position: PRESIDENT
Credential: MD
Phone: 414-372-1000