Healthcare Provider Details

I. General information

NPI: 1548838253
Provider Name (Legal Business Name): U.S. OCCMED WISCONSIN SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 06/17/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4868 S 6TH ST STE 460
MILWAUKEE WI
53221-2462
US

IV. Provider business mailing address

2425 FOUNTAIN VIEW DR STE 160
HOUSTON TX
77057-4834
US

V. Phone/Fax

Practice location:
  • Phone: 414-260-8282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DEAN SHOUCAIR
Title or Position: PRESIDENT
Credential: DO
Phone: 713-880-4400