Healthcare Provider Details

I. General information

NPI: 1386109429
Provider Name (Legal Business Name): ADVOCATE AURORA HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2019
Last Update Date: 02/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 W GOOD HOPE RD
MILWAUKEE WI
53209-2042
US

IV. Provider business mailing address

815 LINCOLN DR W APT 7
WEST BEND WI
53095-4754
US

V. Phone/Fax

Practice location:
  • Phone: 414-352-3100
  • Fax:
Mailing address:
  • Phone: 815-404-9290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: IFEANYI OSUDE
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 815-404-9290