MEDICARE: CITY OF BROOKFIELD

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	3416L0300X	Land Ambulance

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	:	1811001357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF BROOKFIELD

Provider Business Mailing Address
First Line	:	PO BOX 72410
Second Line	:
City	:	CEDARBURG
State	:	WI
Zip	:	53012
Country	:	US
Telephone Number	:	262-375-9610
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 N CALHOUN RD
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53005-5054
Country	:	US
Telephone Number	:	262-782-8932
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MR. DAVID SULIK
Credential	:
Telephone Number	:	262-675-9610

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	10/26/2007

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Directions to “CITY OF BROOKFIELD ” Practice Location

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