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NPI Code Detail

MEDICARE: MIDWEST NEPHROLOGY ASSOCIATES, S.C.

MEDICARE: MIDWEST NEPHROLOGY ASSOCIATES, 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
1207RN0300XNephrology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659304467
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIDWEST NEPHROLOGY ASSOCIATES, S.C.
Provider Business Mailing Address
First Line : 335 MAHN CT
Second Line :
City : OAK CREEK
State : WI
Zip : 53154-2155
Country : US
Telephone Number : 414-762-2020
Fax Number : 414-762-2024
Provider Business Practice Location Address
First Line : 3120 S 27TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53215-4338
Country : US
Telephone Number : 414-672-8282
Fax Number : 414-672-8284
Authorized Official
Title or Position : VP OPERATIONS
Name : CHRISTINE HERBST
Credential :
Telephone Number : 414-762-2020
Provider Enumeration Date : 07/08/2006
Last Update Date : 01/03/2025

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