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General NPI Number Information
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NPI Number | 1043242811
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Entity Type | Organization
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Legal Business Name | FAMILY DOCTORS, SC
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 10/24/2007
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Provider Practice Location Address
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Address Line | 3267 S 16TH ST SUITE 208
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City | MILWAUKEE
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State | WI
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Zip | 53215-4500
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Country | US
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Telephone | 414-643-7448
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Fax | 414-643-7482
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Provider Business Mailing Address
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Address Line | 3267 S 16TH ST SUITE 208
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City | MILWAUKEE
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State | WI
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Zip | 53215-4500
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Country | US
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Telephone | 414-643-7448
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Fax | 414-643-7482
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Authorized Official
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Title or Position | OWNER
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Name | SURESH K MISRA
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Credential | MD
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Telephone | 414-643-7448
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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 | 21429
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License Number State | WI
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