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General NPI Number Information
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NPI Number | 1053591990
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Entity Type | Organization
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Legal Business Name | UROLOGY INSTITUTE OF WAUKESHA SC
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Dates
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Enumeration Date | 11/08/2007
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Last Update Date | 11/08/2007
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Provider Practice Location Address
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Address Line | 1111 DELAFIELD ST STE 12
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City | WAUKESHA
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State | WI
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Zip | 53188-3431
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Country | US
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Telephone | 262-542-9707
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Fax | 262-542-9708
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Provider Business Mailing Address
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Address Line | 1111 DELAFIELD ST STE 12
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City | WAUKESHA
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State | WI
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Zip | 53188-3431
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Country | US
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Telephone | 262-542-9707
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Fax | 262-542-9708
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. W PATRICK FLANAGAN JR.
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Credential |
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Telephone | 262-542-9707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2088P0231X
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Taxonomy Name | Pediatric Urology 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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 29199020
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License Number State | WI
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