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General NPI Number Information
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NPI Number | 1124678354
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Entity Type | Organization
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Legal Business Name | PIC WISCONSIN SC
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Dates
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Enumeration Date | 09/19/2019
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Last Update Date | 09/19/2019
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Provider Practice Location Address
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Address Line | 19165 W BLUEMOUND RD
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City | BROOKFIELD
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State | WI
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Zip | 53045-6076
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Country | US
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Telephone | 847-653-0130
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Fax |
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Provider Business Mailing Address
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Address Line | 9701 W HIGGINS RD STE 270
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City | ROSEMONT
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State | IL
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Zip | 60018-4703
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Country | US
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Telephone | 847-653-0130
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Fax |
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Authorized Official
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Title or Position | SENIOR CREDENTIALING SPECIALIST
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Name | MS. ELIZABETH MILLER
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Credential |
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Telephone | 847-653-0130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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