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General NPI Number Information
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NPI Number | 1609246511
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Entity Type | Organization
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Legal Business Name | MILWAUKEE UROLOGY SPECIALIST
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Dates
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Enumeration Date | 10/05/2015
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Last Update Date | 10/05/2015
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Provider Practice Location Address
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Address Line | 7400 W RAWSON AVE
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City | FRANKLIN
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State | WI
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Zip | 53132-8278
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Country | US
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Telephone | 414-425-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 7400 W RAWSON AVE
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City | FRANKLIN
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State | WI
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Zip | 53132-8278
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. JUDY ENGEVOLD
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Credential |
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Telephone | 414-425-8700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 6617
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License Number State | WI
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