Provider Demographics
NPI:1174653596
Name:MILWAUKEE OCCUPATIONAL MEDICINE SC
Entity Type:Organization
Organization Name:MILWAUKEE OCCUPATIONAL MEDICINE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VANCE
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MASCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-967-0966
Mailing Address - Street 1:377 WEST RIVER WOODS PARKWAY
Mailing Address - Street 2:SUITE 111
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53212
Mailing Address - Country:US
Mailing Address - Phone:414-967-0966
Mailing Address - Fax:414-967-1035
Practice Address - Street 1:377 WEST RIVER WOODS PARKWAY
Practice Address - Street 2:SUITE 111
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53212
Practice Address - Country:US
Practice Address - Phone:414-967-0966
Practice Address - Fax:414-967-1035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
WI371480202083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Multi-Specialty