Healthcare Provider Details
I. General information
NPI: 1992863161
Provider Name (Legal Business Name): PEDIATRIC AND ADULT MEDICINE ASSOCIATES S.C.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 12/04/2006
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
535 N 27TH ST
MILWAUKEE WI
53208-4029
US
IV. Provider business mailing address
535 N 27TH ST
MILWAUKEE WI
53208-4029
US
V. Phone/Fax
- Phone: 414-345-3000
- Fax: 414-345-3001
- Phone: 414-345-3000
- Fax: 414-345-3001
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
VIOLETA
A.
SINGSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 414-345-3000