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General NPI Number Information
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NPI Number | 1104065226
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Entity Type | Organization
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Legal Business Name | METRO MILWAUKEE MEDICAL INC
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Dates
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Enumeration Date | 02/12/2009
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Last Update Date | 05/22/2009
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Provider Practice Location Address
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Address Line | 8901 W LINCOLN AVE
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City | WEST ALLIS
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State | WI
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Zip | 53227-2409
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Country | US
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Telephone | 262-957-7251
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Fax |
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Provider Business Mailing Address
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Address Line | 17345 CIVIC DR P O BOX NO 1570
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City | BROOKFIELD
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State | WI
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Zip | 53045-5305
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Country | US
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Telephone | 262-957-7251
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Fax |
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Authorized Official
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Title or Position | PHISICIAN
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Name | DR. AMI PRAG
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Credential | M.D.
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Telephone | 262-957-7251
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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 | 46478
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License Number State | WI
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