Healthcare Provider Details

I. General information

NPI: 1265659676
Provider Name (Legal Business Name): RIVERSIDE GYNECOLOGY AND WOMEN'S HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22099 DAVIDSON RD 203
WAUKESHA WI
53186-4069
US

IV. Provider business mailing address

22099 DAVIDSON RD 203
WAUKESHA WI
53186-4069
US

V. Phone/Fax

Practice location:
  • Phone: 262-446-6844
  • Fax: 630-665-3868
Mailing address:
  • Phone: 262-446-6844
  • Fax: 630-665-3868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License Number46778
License Number StateWI

VIII. Authorized Official

Name: DR. ELIZABETH ANN BARON-KUHN
Title or Position: PRESIDENT
Credential: MD
Phone: 262-446-6844