Healthcare Provider Details

I. General information

NPI: 1760523559
Provider Name (Legal Business Name): PROHEALTH MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 BIG BEND RD
WAUKESHA WI
53189-7624
US

IV. Provider business mailing address

N17W24100 RIVERWOOD DR SUITE 250
WAUKESHA WI
53188-1177
US

V. Phone/Fax

Practice location:
  • Phone: 262-928-7555
  • Fax: 262-928-7575
Mailing address:
  • Phone: 262-928-4100
  • Fax: 262-928-5835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER GEISS, MD
Title or Position: PRESIDENT
Credential:
Phone: 262-928-8669