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General NPI Number Information
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NPI Number | 1134918063
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Entity Type | Organization
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Legal Business Name | WISCONSIN ANESTHESIA TEAM A SERVICE CORPORATION
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Dates
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Enumeration Date | 05/06/2025
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 805 N MAYFAIR RD
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City | WAUWATOSA
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State | WI
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Zip | 53226-4241
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Country | US
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Telephone | 414-567-0662
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Fax | 414-249-6075
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Provider Business Mailing Address
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Address Line | 9709 LAKESIDE BLVD STE 350
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City | SPRING
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State | TX
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Zip | 77381-1216
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Country | US
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Telephone | 713-489-2198
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Fax | 713-489-2978
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Authorized Official
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Title or Position | OWNER
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Name | EDD EVANS
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Credential | MD
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Telephone | 702-306-6535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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