Healthcare Provider Details

I. General information

NPI: 1275976979
Provider Name (Legal Business Name): ACCENTCARE MEDICAL GROUP OF WISCONSIN, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6737 W WASHINGTON ST STE 2150
WEST ALLIS WI
53214-5647
US

IV. Provider business mailing address

6400 SHAFER CT STE 300A
ROSEMONT IL
60018-4914
US

V. Phone/Fax

Practice location:
  • Phone: 800-379-5105
  • Fax:
Mailing address:
  • Phone: 847-692-1000
  • Fax: 224-532-2780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CARRIE BILL
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 847-692-1148