Healthcare Provider Details

I. General information

NPI: 1356397954
Provider Name (Legal Business Name): MIDWEST COMPREHENSIVE PAIN CARE SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N MAYFAIR RD #300
MILWAUKEE WI
53226
US

IV. Provider business mailing address

2500 N MAYFAIR RD STE 480
MILWAUKEE WI
53226-1443
US

V. Phone/Fax

Practice location:
  • Phone: 414-771-7400
  • Fax: 414-771-4992
Mailing address:
  • Phone: 414-771-7400
  • Fax: 414-771-4992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number StateWI

VIII. Authorized Official

Name: DR. NANCY C BRATANOW
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 414-771-7400