Healthcare Provider Details

I. General information

NPI: 1184805848
Provider Name (Legal Business Name): ALLIANCE ENT AND HEARING CENTER, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 N MAYFAIR RD STE I
WAUWATOSA WI
53222-4400
US

IV. Provider business mailing address

PO BOX 26071
WAUWATOSA WI
53226-0071
US

V. Phone/Fax

Practice location:
  • Phone: 414-727-0910
  • Fax: 414-727-0920
Mailing address:
  • Phone: 414-727-0910
  • Fax: 414-727-0920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ANTHONY A RIEDER
Title or Position: OWNER
Credential: M.D.
Phone: 414-727-0910