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General NPI Number Information
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NPI Number | 1518079771
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Entity Type | Organization
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Legal Business Name | PARKLAND FAMILY PHYSICIANS SC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 4448 W LOOMIS ROAD SUITE #101
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City | GREENFIELD
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State | WI
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Zip | 53220-4817
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Country | US
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Telephone | 414-282-4443
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Fax | 414-282-2278
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Provider Business Mailing Address
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Address Line | 4448 W LOOMIS ROAD SUITE #101
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City | GREENFIELD
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State | WI
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Zip | 53220-4817
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Country | US
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Telephone | 414-282-4443
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Fax | 414-282-2278
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. DONALD D NIMMER
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Credential | MD
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Telephone | 414-282-4443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 29494
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 29409
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License Number State | WI
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