MEDICARE: WHEATON FRANCISCAN MEDICAL GROUP

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	207Q00000X	Family Medicine Physician
2	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1013860015	OTHER	WI	DME

General Provider Information

NPI Number	:	1679655005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHEATON FRANCISCAN MEDICAL GROUP

Provider Business Mailing Address
First Line	:	3970 N OAKLAND AVE
Second Line	:
City	:	SHOREWOOD
State	:	WI
Zip	:	53211-2265
Country	:	US
Telephone Number	:	414-527-5690
Fax Number	:	414-527-5695

Provider Business Practice Location Address
First Line	:	3970 N OAKLAND AVE
Second Line	:
City	:	SHOREWOOD
State	:	WI
Zip	:	53211-2265
Country	:	US
Telephone Number	:	414-527-5690
Fax Number	:	414-527-5695

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	LARRY WADE
Credential	:
Telephone Number	:	414-465-3000

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	09/11/2025

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