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General NPI Number Information
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NPI Number | 1760819312
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Entity Type | Organization
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Legal Business Name | CHILDREN'S HOSPITAL OF WISCONSIN
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Dates
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Enumeration Date | 09/27/2013
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Last Update Date | 09/27/2013
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Provider Practice Location Address
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Address Line | W4063 HWY NN
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City | ELKHORN
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State | WI
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Zip | 53121-4338
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Country | US
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Telephone | 262-741-1440
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Fax | 262-743-2220
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Provider Business Mailing Address
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Address Line | 9000 W WISCONSIN AVE MS 958
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City | MILWAUKEE
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State | WI
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Zip | 53226-4874
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Country | US
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Telephone | 414-266-7615
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Fax | 414-266-6238
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Authorized Official
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Title or Position | TREASURER/CHIEF FINANCIAL OFFICER
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Name | WELDON GAGE
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Credential |
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Telephone | 414-266-6401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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