Provider Demographics
NPI:1164573358
Name:FAMILY MEDICINE ASSOCIATES
Entity Type:Organization
Organization Name:FAMILY MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAENPAA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-327-4450
Mailing Address - Street 1:3738 S 60TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53220-1935
Mailing Address - Country:US
Mailing Address - Phone:414-327-4450
Mailing Address - Fax:414-327-1464
Practice Address - Street 1:3738 S 60TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53220-1935
Practice Address - Country:US
Practice Address - Phone:414-327-4450
Practice Address - Fax:414-327-1464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI01460207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty