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General NPI Number Information
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NPI Number | 1659666378
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Entity Type | Organization
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Legal Business Name | STAUDACHER CARDIOLOGY SERVICES, SC
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Dates
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Enumeration Date | 06/10/2011
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Last Update Date | 06/14/2011
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Provider Practice Location Address
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Address Line | 721 AMERICAN AVE SUITE 411
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City | WAUKESHA
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State | WI
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Zip | 53188-5071
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Country | US
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Telephone | 262-896-4608
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Fax | 262-896-4643
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Provider Business Mailing Address
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Address Line | 721 AMERICAN AVE SUITE 411
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City | WAUKESHA
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State | WI
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Zip | 53188-5071
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Country | US
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Telephone | 262-896-4608
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Fax | 262-896-4643
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. RICHARD STAUDACHER
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Credential | M.D.
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Telephone | 262-227-6589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 31083-20
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 31083-20
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License Number State | WI
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