MEDICARE: E & G PRENATAL CARE

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1548745771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E & G PRENATAL CARE

Provider Business Mailing Address
First Line	:	8018 W CAPITOL DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-1906
Country	:	US
Telephone Number	:	414-395-5502
Fax Number	:

Provider Business Practice Location Address
First Line	:	8018 W CAPITOL DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-1906
Country	:	US
Telephone Number	:	414-395-5502
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	TIFFANY D GRIFFIN
Credential	:
Telephone Number	:	414-395-5502

Provider Enumeration Date	:	10/03/2018
Last Update Date	:	10/03/2018

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