=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972528263
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZANE P. PREWITT M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2006
-----------------------------------------------------
Last Update Date | 12/28/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | N84W16889 MENOMONEE AVE
-----------------------------------------------------
City | MENOMONEE FALLS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53051-2810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-251-7500
-----------------------------------------------------
Fax | 262-251-7128
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3003 W GOOD HOPE RD
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53209-2042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-352-3100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 35422
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------