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General NPI Number Information
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NPI Number | 1740274687
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Entity Type | Organization
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Legal Business Name | WAUKESHA FAMILY PRACTICE CLINIC, LTD.
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Dates
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Enumeration Date | 09/07/2005
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 237 WISCONSIN AVE
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City | WAUKESHA
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State | WI
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Zip | 53186-4955
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Country | US
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Telephone | 262-542-5557
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Fax | 262-542-6199
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Provider Business Mailing Address
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Address Line | 237 WISCONSIN AVE
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City | WAUKESHA
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State | WI
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Zip | 53186-4955
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Country | US
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Telephone | 262-542-5557
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Fax | 262-542-6199
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT J BEAUMONT
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Credential | D.O.
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Telephone | 262-542-5557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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