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General NPI Number Information
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NPI Number | 1285684506
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Entity Type | Organization
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Legal Business Name | INFECTIOUS DISEASE SPECIALISTS OF SE WI, SC
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 12/02/2011
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Provider Practice Location Address
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Address Line | 150 S. SUNNY SLOPE RD SUITE 136
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City | BROOKFIELD
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State | WI
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Zip | 53005
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Country | US
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Telephone | 262-786-4550
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Fax | 262-786-4552
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Provider Business Mailing Address
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Address Line | 150 S. SUNNY SLOPE RD SUITE 136
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City | BROOKFIELD
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State | WI
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Zip | 53005
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Country | US
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Telephone | 262-786-4550
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Fax | 262-786-4552
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Authorized Official
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Title or Position | SECRETARY / TREASURER
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Name | DAVID M LETZER
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Credential | DO
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Telephone | 262-786-4550
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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 |
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License Number State |
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