Healthcare Provider Details

I. General information

NPI: 1558807131
Provider Name (Legal Business Name): MIDWEST NEPHROLOGY ASSOCIATES, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2017
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7797 W APPLETON AVENUE
MILWAUKEE WI
53222
US

IV. Provider business mailing address

335 MAHN COURT
OAK CREEK WI
53154-2155
US

V. Phone/Fax

Practice location:
  • Phone: 414-393-2690
  • Fax: 414-393-2693
Mailing address:
  • Phone: 414-762-2020
  • Fax: 414-762-2024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE HERBST
Title or Position: VP OPERATIONS
Credential:
Phone: 414-762-2020