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General NPI Number Information
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NPI Number | 1174822480
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Entity Type | Organization
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Legal Business Name | MIDWEST INFECTIOUS DISEASE
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Dates
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Enumeration Date | 03/25/2011
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Last Update Date | 03/29/2011
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Provider Practice Location Address
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Address Line | 2900 W OKLAHOMA AVE
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City | MILWAUKEE
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State | WI
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Zip | 53215-4330
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Country | US
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Telephone | 414-649-3872
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Fax | 414-375-0192
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Provider Business Mailing Address
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Address Line | 1210 S JAMES ST
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City | BROOKFIELD
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State | WI
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Zip | 53005-7191
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Country | US
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Telephone | 414-649-3872
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Fax | 414-375-0192
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN C CHRISTIANSON
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Credential | MD
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Telephone | 414-649-3872
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 27387-20
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License Number State | WI
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