MEDICARE: ENT ASSOCIATES SC

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	207Y00000X	Otolaryngology Physician	24504	WI
2	207Y00000X	Otolaryngology Physician	34875	WI
3	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	40673	WI

General Provider Information

NPI Number	:	1881819092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENT ASSOCIATES SC

Provider Business Mailing Address
First Line	:	2315 N LAKE DR STE 1005
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-4516
Country	:	US
Telephone Number	:	414-271-4141
Fax Number	:	414-271-4343

Provider Business Practice Location Address
First Line	:	2315 N LAKE DR STE 1005
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-4516
Country	:	US
Telephone Number	:	414-271-4141
Fax Number	:	414-271-4343

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GRETCHEN E DURKIN
Credential	:	M.D.
Telephone Number	:	414-271-4141

Provider Enumeration Date	:	04/14/2007
Last Update Date	:	09/11/2025

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Directions to “ENT ASSOCIATES SC ” Practice Location

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