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General NPI Number Information
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NPI Number | 1528208170
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Entity Type | Organization
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Legal Business Name | MARQUETTE UNIVERSITY
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Dates
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Enumeration Date | 02/23/2009
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Last Update Date | 02/23/2009
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Provider Practice Location Address
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Address Line | 561 N 15TH ST ROOM 171A
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City | MILWAUKEE
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State | WI
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Zip | 53233-2237
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Country | US
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Telephone | 414-288-4556
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Fax | 414-288-6100
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Provider Business Mailing Address
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Address Line | 561 N. 15 STREET ROOM 171A
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City | MILWAUKEE
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State | WI
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Zip | 53233
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Country | US
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Telephone | 414-288-4556
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Fax | 414-288-6100
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Authorized Official
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Title or Position | CHIEF OF OPERATIONS
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Name | MR. BRIAN SHOUP
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Credential |
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Telephone | 414-288-7378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | WI
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