Healthcare Provider Details

I. General information

NPI: 1639100720
Provider Name (Legal Business Name): GREATER MILWAUKEE MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7620 W BURLEIGH ST
MILWAUKEE WI
53222-5002
US

IV. Provider business mailing address

PO BOX 11943
SHOREWOOD WI
53211-0943
US

V. Phone/Fax

Practice location:
  • Phone: 414-444-6000
  • Fax: 888-664-5360
Mailing address:
  • Phone: 414-444-6000
  • Fax: 888-664-5360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: CJ RAYCHEL
Title or Position: COMPLIANCE OFFICER
Credential:
Phone: 414-444-6000