MEDICARE: WISCONSIN HEART CENTER S C

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	207RC0000X	Cardiovascular Disease 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

General Provider Information

NPI Number	:	1073549739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISCONSIN HEART CENTER S C

Provider Business Mailing Address
First Line	:	1233 N MAYFAIR RD
Second Line	:	SUITE 201
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-3255
Country	:	US
Telephone Number	:	414-774-6300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1233 N MAYFAIR RD
Second Line	:	SUITE 201
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-3255
Country	:	US
Telephone Number	:	414-774-6300
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL D BECKER
Credential	:	MD
Telephone Number	:	414-481-8400

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	09/24/2014

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