MEDICARE: PROHEALTH MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	208600000X	Surgery Physician
2	207K00000X	Allergy & Immunology Physician
3	207R00000X	Internal Medicine Physician
4	207RC0000X	Cardiovascular Disease Physician
5	207Q00000X	Family Medicine 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	:	1760523559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROHEALTH MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	N17W24100 RIVERWOOD DR
Second Line	:	SUITE 250
City	:	WAUKESHA
State	:	WI
Zip	:	53188-1177
Country	:	US
Telephone Number	:	262-928-4100
Fax Number	:	262-928-5835

Provider Business Practice Location Address
First Line	:	2130 BIG BEND RD
Second Line	:
City	:	WAUKESHA
State	:	WI
Zip	:	53189-7624
Country	:	US
Telephone Number	:	262-928-7555
Fax Number	:	262-928-7575

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PETER GEISS, MD
Credential	:
Telephone Number	:	262-928-8669

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	05/24/2022

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1689647406 — CARYN A. BROWNELL M.D.
Practice Location Address:

2130 BIG BEND ROAD , PROHEALTH CARE MEDICAL ASSOCIATES, INC.
WAUKESHA, WI
53189-7624

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1841250057 — DR. LAWRENCE EDWARD WALTER M.D.
Practice Location Address:

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53189-7624

Practice Phone: 262-928-7555
Practice Fax: 262-928-7575

Directions to “PROHEALTH MEDICAL GROUP INC ” Practice Location

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