=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144214388
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICHARD A STELIGA MD SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2005
-----------------------------------------------------
Last Update Date | 03/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3070 N 51ST ST STE 405
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53210-1661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-871-8888
-----------------------------------------------------
Fax | 414-871-9035
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3070 N 51ST ST STE 405
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53210-1661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-871-8888
-----------------------------------------------------
Fax | 414-871-9035
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. RICHARD ALLEN STELIGA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 414-871-8888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 18634
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------