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General NPI Number Information
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NPI Number | 1649700980
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Entity Type | Organization
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Legal Business Name | FROEDTERT &THE MEDICAL COLLEGE OF WISCONSIN COMMUNITY PHYSICIANS INC
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Dates
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Enumeration Date | 06/19/2017
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Last Update Date | 07/19/2024
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Provider Practice Location Address
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Address Line | 7901 SOUTH 6TH STREET
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City | OAK CREEK
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State | WI
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Zip | 53154
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Country | US
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Telephone | 414-346-8000
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Fax |
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Provider Business Mailing Address
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Address Line | N74W12501 LEATHERWOOD CT
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-4490
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Country | US
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Telephone | 414-777-0417
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | AMIR ABBAS GHAFERI
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Credential | MD
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Telephone | 734-660-4939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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