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General NPI Number Information
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NPI Number | 1770862054
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Entity Type | Organization
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Legal Business Name | ALEX COLQUE, M.D. S.C.
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Dates
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Enumeration Date | 08/04/2011
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Last Update Date | 02/03/2020
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Provider Practice Location Address
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Address Line | 21675 E MORELAND BLVD SUITE 100
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City | WAUKESHA
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State | WI
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Zip | 53186
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Country | US
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Telephone | 262-781-9000
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Fax | 262-395-4068
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Provider Business Mailing Address
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Address Line | 21675 E MORELAND BLVD SUITE 100
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City | WAUKESHA
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State | WI
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Zip | 53186
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Country | US
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Telephone | 262-781-9000
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Fax | 262-395-4068
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | DR. ALEX P COLQUE
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Credential | MD
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Telephone | 262-781-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 55219020
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License Number State | WI
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