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General NPI Number Information
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NPI Number | 1891799755
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Entity Type | Organization
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Legal Business Name | UROLOGY SPECIALISTS S.C.
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2350 W VILLARD AVE STE 301
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City | MILWAUKEE
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State | WI
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Zip | 53209-5084
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Country | US
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Telephone | 414-527-3000
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Fax | 414-527-3114
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Provider Business Mailing Address
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Address Line | 2350 W VILLARD AVE STE 301
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City | MILWAUKEE
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State | WI
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Zip | 53209-5084
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Country | US
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Telephone | 414-527-3000
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Fax | 414-527-3114
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Authorized Official
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Title or Position | SENIOR PARTNER
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Name | DR. MITCHELL WIATRAK
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Credential | M.D.
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Telephone | 414-527-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 31968
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 37739
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 45820
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 457-023
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License Number State | WI
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