MEDICARE: UNITED OCCUPATIONAL MEDICINE AND WALK IN SERVICES, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207P00000X	Emergency Medicine Physician
2	363A00000X	Physician Assistant
3	363L00000X	Nurse Practitioner
4	2083X0100X	Occupational Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	CI2829	OTHER	WI	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	137569000	OTHER	WI	OWCP
2	120002371	OTHER	WI	WEA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	020446500	OTHER	WI	FEDERAL BLACK LUNG PROGRA

General Provider Information

NPI Number	:	1518915073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED OCCUPATIONAL MEDICINE AND WALK IN SERVICES, LLC

Provider Business Mailing Address
First Line	:	111 E WISCONSIN AVE
Second Line	:	SUITE 2000
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-4815
Country	:	US
Telephone Number	:	414-290-6718
Fax Number	:	414-290-6755

Provider Business Practice Location Address
First Line	:	9555 76TH ST
Second Line	:
City	:	PLEASANT PRAIRIE
State	:	WI
Zip	:	53158-1984
Country	:	US
Telephone Number	:	414-290-6718
Fax Number	:	414-290-6755

Authorized Official
Title or Position	:	OFFICER
Name	:	KATHY KONDAS
Credential	:
Telephone Number	:	414-290-6718

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	08/28/2019

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Directions to “UNITED OCCUPATIONAL MEDICINE AND WALK IN SERVICES, LLC ” Practice Location

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