=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528544608
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APOGEE MEDICAL GROUP WAUKESHA, SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2018
-----------------------------------------------------
Last Update Date | 07/12/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 725 AMERICAN AVE
-----------------------------------------------------
City | WAUKESHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53188-5031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-928-5400
-----------------------------------------------------
Fax | 262-928-6140
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 708878
-----------------------------------------------------
City | SANDY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84070-8878
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-352-9500
-----------------------------------------------------
Fax | 801-352-7976
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | KAREN HARWELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 602-778-3600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------