Provider Demographics
NPI:1083759385
Name:GREATER MILWAUKEE SURGICAL ASSOCIATES SC
Entity Type:Organization
Organization Name:GREATER MILWAUKEE SURGICAL ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MALECKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-384-8388
Mailing Address - Street 1:3033 S 27TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3600
Mailing Address - Country:US
Mailing Address - Phone:414-384-8388
Mailing Address - Fax:
Practice Address - Street 1:3033 S 27TH ST STE 200
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3600
Practice Address - Country:US
Practice Address - Phone:414-384-8388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21339174400000X
WI19125174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32885700Medicaid
WID79167Medicare UPIN
WIB54854Medicare UPIN
WI32885700Medicaid