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General NPI Number Information
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NPI Number | 1356892376
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Entity Type | Organization
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Legal Business Name | THE MEDICAL COLLEGE OF WISCONSIN INC
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Dates
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Enumeration Date | 10/14/2016
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Last Update Date | 10/14/2016
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Provider Practice Location Address
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Address Line | 11340 W THEODORE TRECKER WAY
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City | WEST ALLIS
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State | WI
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Zip | 53214-1135
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Country | US
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Telephone | 800-881-5101
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Fax |
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Provider Business Mailing Address
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Address Line | 8701 W WATERTOWN PLANK RD MEDICAL EDUCATION BUILDING M1552
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City | MILWAUKEE
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State | WI
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Zip | 53226-3548
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Country | US
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Telephone | 414-955-2859
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Fax |
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Authorized Official
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Title or Position | ASSISTANT PROFESSOR
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Name | KATHERINE NORA GHARIBIAN
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Credential | PHARM.D.
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Telephone | 414-955-2859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | 18653-40
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License Number State | WI
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