Provider Demographics
NPI:1063481869
Name:CARDIOLOGY ASSOCIATES OF WAUKESHA, S.C.
Entity Type:Organization
Organization Name:CARDIOLOGY ASSOCIATES OF WAUKESHA, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:NESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-549-0167
Mailing Address - Street 1:721 AMERICAN AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5071
Mailing Address - Country:US
Mailing Address - Phone:262-549-1516
Mailing Address - Fax:262-549-0648
Practice Address - Street 1:721 AMERICAN AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5071
Practice Address - Country:US
Practice Address - Phone:262-549-1516
Practice Address - Fax:262-549-0648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32898000Medicaid
WI68120Medicare ID - Type Unspecified