Healthcare Provider Details

I. General information

NPI: 1740309061
Provider Name (Legal Business Name): MILWAUKEE CARDIOVASCULAR CNTR S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2778 S 35TH ST #101
MILWAUKEE WI
53215-3578
US

IV. Provider business mailing address

2778 S 35TH ST #101
MILWAUKEE WI
53215-3578
US

V. Phone/Fax

Practice location:
  • Phone: 414-672-7200
  • Fax: 414-672-7400
Mailing address:
  • Phone: 414-672-7200
  • Fax: 414-672-7400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RUBEN F LEWIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 414-672-7200