Provider Demographics
NPI:1023020062
Name:COLUMBIA CARDIOGRAPHIC CONSULTANTS, LTD.
Entity Type:Organization
Organization Name:COLUMBIA CARDIOGRAPHIC CONSULTANTS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-961-3300
Mailing Address - Street 1:PO BOX 1790
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53008-1790
Mailing Address - Country:US
Mailing Address - Phone:888-850-0494
Mailing Address - Fax:262-641-6893
Practice Address - Street 1:2025 E NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-2906
Practice Address - Country:US
Practice Address - Phone:414-961-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32693500Medicaid
WIB57420Medicare UPIN
WI32693500Medicaid