Provider Demographics
NPI:1114902293
Name:DIGESTIVE DISEASE SPECIALISTS OF WI
Entity Type:Organization
Organization Name:DIGESTIVE DISEASE SPECIALISTS OF WI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JO
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:SADOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-896-6400
Mailing Address - Street 1:W231N1440 CORPORATE CT
Mailing Address - Street 2:SUITE 307
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-1303
Mailing Address - Country:US
Mailing Address - Phone:262-896-6400
Mailing Address - Fax:262-896-8986
Practice Address - Street 1:W231N1440 CORPORATE CT
Practice Address - Street 2:SUITE 307
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1303
Practice Address - Country:US
Practice Address - Phone:262-896-6400
Practice Address - Fax:262-896-8986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32865400Medicaid