MEDICARE: UROLOGY SPECIALISTS 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
1	174400000X	Specialist	31968	WI
2	174400000X	Specialist	37739	WI
3	174400000X	Specialist	45820	WI
4	363A00000X	Physician Assistant	457-023	WI

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891799755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UROLOGY SPECIALISTS S.C.

Provider Business Mailing Address
First Line	:	2350 W VILLARD AVE
Second Line	:	STE 301
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-5084
Country	:	US
Telephone Number	:	414-527-3000
Fax Number	:	414-527-3114

Provider Business Practice Location Address
First Line	:	2350 W VILLARD AVE
Second Line	:	STE 301
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-5084
Country	:	US
Telephone Number	:	414-527-3000
Fax Number	:	414-527-3114

Authorized Official
Title or Position	:	SENIOR PARTNER
Name	:	DR. MITCHELL WIATRAK
Credential	:	M.D.
Telephone Number	:	414-527-3000

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	09/11/2025

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Directions to “UROLOGY SPECIALISTS S.C. ” Practice Location

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