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General NPI Number Information
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NPI Number | 1528006277
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Entity Type | Organization
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Legal Business Name | SHOREWOOD FAMILY PHYSICIANS S C
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1901 E CAPITOL DR
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City | SHOREWOOD
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State | WI
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Zip | 53211-2335
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Country | US
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Telephone | 414-962-7477
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Fax | 414-962-2420
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Provider Business Mailing Address
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Address Line | 1901 E CAPITOL DR
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City | SHOREWOOD
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State | WI
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Zip | 53211-2335
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Country | US
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Telephone | 414-962-7477
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Fax | 414-962-2420
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JACQUELINE A PETRUZATES
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Credential |
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Telephone | 414-962-7477
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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 |
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License Number State |
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