Healthcare Provider Details

I. General information

NPI: 1497726392
Provider Name (Legal Business Name): JOSEPH MICHAEL ZOMPA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N GRANDVIEW BLVD W-685
WAUKESHA WI
53188-1615
US

IV. Provider business mailing address

PO BOX 506
PEWAUKEE WI
53072-0506
US

V. Phone/Fax

Practice location:
  • Phone: 262-544-3600
  • Fax: 262-544-3091
Mailing address:
  • Phone: 262-544-3600
  • Fax: 262-544-3091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number39831-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: