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General NPI Number Information
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NPI Number | 1326086943
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Entity Type | Organization
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Legal Business Name | WISCONSIN HEART GROUP
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 16650 W BLUEMOUND RD SUITE 200
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City | BROOKFIELD
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State | WI
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Zip | 53005-5920
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Country | US
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Telephone | 262-827-9200
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Fax | 262-827-9858
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Provider Business Mailing Address
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Address Line | 16650 W BLUEMOUND RD SUITE 200
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City | BROOKFIELD
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State | WI
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Zip | 53005-5920
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Country | US
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Telephone | 262-827-9200
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Fax | 262-827-9858
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Authorized Official
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Title or Position | M.D. & PRESIDENT
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Name | MR. DAVID L. GRODEN
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Credential | M.D.
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Telephone | 262-827-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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