MEDICARE: MILWAUKEE CARDIAC CARE LLC

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	207RC0000X	Cardiovascular Disease 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	:	1982625885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILWAUKEE CARDIAC CARE LLC

Provider Business Mailing Address
First Line	:	4555 W SCHROEDER DR
Second Line	:	#170
City	:	MILWAUKEE
State	:	WI
Zip	:	53223-1475
Country	:	US
Telephone Number	:	414-365-3210
Fax Number	:

Provider Business Practice Location Address
First Line	:	5434 W CAPITOL DR STE 1
Second Line	:	#1
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2298
Country	:	US
Telephone Number	:	414-442-5400
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MAQSOOD AHMAD
Credential	:	MD
Telephone Number	:	414-442-5400

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	10/15/2010

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