Provider Demographics
NPI:1003320417
Name:ALLIANCE ENT & HEARING CENTER, S.C.
Entity Type:Organization
Organization Name:ALLIANCE ENT & HEARING CENTER, S.C.
Other - Org Name:WINNER'S EDGE PERFORMANCE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RIEDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-727-0910
Mailing Address - Street 1:201 N MAYFAIR RD STE 515
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4216
Mailing Address - Country:US
Mailing Address - Phone:414-727-0910
Mailing Address - Fax:414-727-0920
Practice Address - Street 1:1251 E WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-3755
Practice Address - Country:US
Practice Address - Phone:262-696-9096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLIANCE ENT & HEARING CENTER, S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep MedicineGroup - Multi-Specialty