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General NPI Number Information
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NPI Number | 1508988239
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Entity Type | Organization
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Legal Business Name | MILWAUKEE GENERAL & VASCULAR SURGERY SC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 06/24/2010
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Provider Practice Location Address
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Address Line | 10400 W NORTH AVE #480
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City | MILWAUKEE
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State | WI
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Zip | 53226-2425
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Country | US
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Telephone | 414-778-6670
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Fax | 414-778-6672
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Provider Business Mailing Address
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Address Line | 10400 W NORTH AVE #480
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City | MILWAUKEE
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State | WI
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Zip | 53226-2425
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Country | US
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Telephone | 414-778-6670
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Fax | 414-778-6672
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Authorized Official
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Title or Position | VICE PRESIDENT PARTNER
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Name | GREGORY ALAN EKBOM
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Credential | MD
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Telephone | 414-778-6670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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