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General NPI Number Information
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NPI Number | 1396193033
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Entity Type | Organization
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Legal Business Name | NEW BERLIN MEDICAL SERVICES, LLC
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Dates
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Enumeration Date | 06/02/2016
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Last Update Date | 06/02/2016
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Provider Practice Location Address
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Address Line | 15324 W BELOIT ROAD
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City | NEW BERLIN
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State | WI
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Zip | 53151
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Country | US
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Telephone | 414-761-0981
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Fax | 414-761-1614
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Provider Business Mailing Address
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Address Line | 8153 S 27TH ST SUITE 400
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City | FRANKLIN
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State | WI
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Zip | 53132-9549
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Country | US
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Telephone | 414-304-5311
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Fax | 414-761-1614
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT DONALD MATTEUCCI SR.
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Credential | D.P.M.
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Telephone | 414-761-0981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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