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General NPI Number Information
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NPI Number | 1093425647
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Entity Type | Organization
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Legal Business Name | MIDWEST CRITICAL CARE SC
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Dates
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Enumeration Date | 12/05/2022
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Last Update Date | 01/31/2023
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Provider Practice Location Address
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Address Line | 3801 SPRING ST
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City | MOUNT PLEASANT
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State | WI
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Zip | 53405-1667
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Country | US
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Telephone | 262-687-4011
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 N COMMERCE ST UNIT 300
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City | MILWAUKEE
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State | WI
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Zip | 53212-3785
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Country | US
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Telephone | 602-738-1478
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KRISTI MASO
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Credential | MD
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Telephone | 602-738-1478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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