Healthcare Provider Details

I. General information

NPI: 1053591990
Provider Name (Legal Business Name): UROLOGY INSTITUTE OF WAUKESHA SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 DELAFIELD ST STE 12
WAUKESHA WI
53188-3431
US

IV. Provider business mailing address

1111 DELAFIELD ST STE 12
WAUKESHA WI
53188-3431
US

V. Phone/Fax

Practice location:
  • Phone: 262-542-9707
  • Fax: 262-542-9708
Mailing address:
  • Phone: 262-542-9707
  • Fax: 262-542-9708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number29199020
License Number StateWI

VIII. Authorized Official

Name: DR. W PATRICK FLANAGAN JR.
Title or Position: OWNER/PHYSICIAN
Credential:
Phone: 262-542-9707