Healthcare Provider Details

I. General information

NPI: 1346214897
Provider Name (Legal Business Name): RYSZARD CHOLEWA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 GATEWAY CT
WEST BEND WI
53095-8539
US

IV. Provider business mailing address

3003 W GOOD HOPE RD
MILWAUKEE WI
53209-2042
US

V. Phone/Fax

Practice location:
  • Phone: 262-335-8600
  • Fax:
Mailing address:
  • Phone: 414-352-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number45828
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: