MEDICARE: WATERTOWER PAIN CONSULTANTS, SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	52D1088766	OTHER		CLIA

General Provider Information

NPI Number	:	1053389544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WATERTOWER PAIN CONSULTANTS, SC

Provider Business Mailing Address
First Line	:	575 W RIVER WOODS PKWY
Second Line	:	#205
City	:	GLENDALE
State	:	WI
Zip	:	53212-1003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	575 W RIVER WOODS PKWY
Second Line	:	#205
City	:	GLENDALE
State	:	WI
Zip	:	53212-1003
Country	:	US
Telephone Number	:	414-962-6700
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEPHEN DONATELLO
Credential	:	MD
Telephone Number	:	414-962-6700

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	10/09/2008

Similar Medicare Providers

1538114574 — JAMES G KLAMIK MD
Practice Location Address:

575 W RIVER WOODS PKWY
GLENDALE, WI
53212-1003

Practice Phone: 414-961-6700
Practice Fax: 414-961-6727

1821116419 — KIRSTEN J SIMANONOK MDSC
Practice Location Address:

575 W RIVER WOODS PKWY
GLENDALE, WI
53212-1003

Practice Phone: 414-961-6700
Practice Fax: 414-961-6727

1164724407 — JAMES H. LANGENKAMP, M.D., S.C.
Practice Location Address:

575 W RIVER WOODS PKWY , SUITE 204
GLENDALE, WI
53212-1003

Practice Phone: 414-332-9898
Practice Fax: 414-332-6849

1720182397 — MR. MARTIN JOSEPH NABER OPA, SA-C
Practice Location Address:

575 W RIVER WOODS PKWY , SUITE 305
MILWAUKEE, WI
53212-1003

Practice Phone: 414-961-2225
Practice Fax: 414-961-0298

1124359880 — MILWAUKEE SPINAL SPECIALISTS, S.C.
Practice Location Address:

575 W. RIVER WOODS PKWY , SUITE 305
MILWAUKEE, WI
53212-1003

Practice Phone: 414-961-2225
Practice Fax: 414-961-0298

1508101072 — KHT CARE PLUS GROUP INC
Practice Location Address:

705 IVY ST
GLENDALE, CA
91204-1003

Practice Phone: 818-637-4838
Practice Fax: 818-637-4857

Directions to “WATERTOWER PAIN CONSULTANTS, SC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.