Healthcare Provider Details

I. General information

NPI: 1578538617
Provider Name (Legal Business Name): JOSEPH TZOUGROS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N14W23900 STONE RIDGE DR PROHEALTH CARE MEDICAL ASSOCIATES INC.
WAUKESHA WI
53188-1135
US

IV. Provider business mailing address

N14W23900 STONE RIDGE DR PROHEALTH CARE MEDICAL ASSOCIATES INC.
WAUKESHA WI
53188-1135
US

V. Phone/Fax

Practice location:
  • Phone: 262-549-3030
  • Fax:
Mailing address:
  • Phone: 262-549-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number31408
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: