Provider Demographics
NPI:1043313505
Name:MAURICIO TOVAR MD SC
Entity Type:Organization
Organization Name:MAURICIO TOVAR MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAURICIO
Authorized Official - Middle Name:
Authorized Official - Last Name:TOVAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-281-9533
Mailing Address - Street 1:PO BOX 511774
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202
Mailing Address - Country:US
Mailing Address - Phone:414-281-9533
Mailing Address - Fax:414-281-9548
Practice Address - Street 1:4931 S 27TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53221
Practice Address - Country:US
Practice Address - Phone:414-281-9533
Practice Address - Fax:414-281-9548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31738207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32105700Medicaid
WI01856Medicare ID - Type Unspecified
WI32105700Medicaid