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General NPI Number Information
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NPI Number | 1720604044
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Entity Type | Organization
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Legal Business Name | FROEDTERT & MEDICAL COLLEGE OF WI COMMUNITY PHYSICIANS
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Dates
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Enumeration Date | 06/23/2020
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Last Update Date | 06/23/2020
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Provider Practice Location Address
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Address Line | 1700 PARADISE DR
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City | WEST BEND
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State | WI
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Zip | 53095-9795
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Country | US
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Telephone | 262-253-5230
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 PARADISE DR
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City | WEST BEND
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State | WI
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Zip | 53095-9795
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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 | VP FINANCE
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Name | RANDALL NEWMAN
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Credential |
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Telephone | 414-777-7963
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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