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General NPI Number Information
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NPI Number | 1538839618
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Entity Type | Organization
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Legal Business Name | PROHEALTH MEDICAL GROUP INC
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Dates
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Enumeration Date | 09/20/2021
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Last Update Date | 05/23/2022
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Provider Practice Location Address
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Address Line | 1279 CAPITOL DR
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City | PEWAUKEE
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State | WI
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Zip | 53072-2504
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Country | US
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Telephone | 262-928-9180
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Fax |
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Provider Business Mailing Address
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Address Line | N17W24100 RIVERWOOD DR
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City | WAUKESHA
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State | WI
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Zip | 53188-1127
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Country | US
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Telephone | 262-928-4704
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Fax |
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Authorized Official
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Title or Position | REIMBURSEMENT MANAGER
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Name | THOMAS W JOHNSON
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Credential |
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Telephone | 262-928-4704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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