MEDICARE: WISCONSIN BARIATRICS, 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	208600000X	Surgery 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	:	1952374878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISCONSIN BARIATRICS, SC

Provider Business Mailing Address
First Line	:	4600 W LOOMIS RD
Second Line	:	SUITE 101
City	:	MILWAUKEE
State	:	WI
Zip	:	53220-4858
Country	:	US
Telephone Number	:	414-281-9665
Fax Number	:	414-281-9674

Provider Business Practice Location Address
First Line	:	4600 W LOOMIS RD
Second Line	:	SUITE 101
City	:	MILWAUKEE
State	:	WI
Zip	:	53220-4858
Country	:	US
Telephone Number	:	414-281-9665
Fax Number	:	414-281-9674

Authorized Official
Title or Position	:	BILLING REP
Name	:	DANA L PAUL
Credential	:
Telephone Number	:	414-281-9665

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	10/29/2007

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