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General NPI Number Information
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NPI Number | 1023064482
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Entity Type | Organization
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Legal Business Name | COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE, INC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 2350 N LAKE DR
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City | MILWAUKEE
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State | WI
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Zip | 53211
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Country | US
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Telephone | 414-585-1000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 860496
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City | MINNEAPOLIS
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State | MN
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Zip | 55486-0496
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Country | US
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Telephone | 414-585-1000
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MICHAEL MCCULLOUGH
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Credential |
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Telephone | 414-465-3736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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