Healthcare Provider Details

I. General information

NPI: 1831437581
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL OF WISCONSIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 W WALNUT ST
MILWAUKEE WI
53212-3839
US

IV. Provider business mailing address

9000 W WISCONSIN AVE MS 958
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-277-8980
  • Fax: 414-277-8969
Mailing address:
  • Phone: 414-266-7615
  • Fax: 414-266-6238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: CADIEUX MARC
Title or Position: TREASURER/CHIEF FINANCIAL OFFICER
Credential:
Phone: 414-266-6401