Provider Demographics
NPI:1184654121
Name:RACINE EMERGENCY PHYSICIANS, S.C.
Entity Type:Organization
Organization Name:RACINE EMERGENCY PHYSICIANS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:MANSKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-687-4479
Mailing Address - Street 1:3805B SPRING ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-1641
Mailing Address - Country:US
Mailing Address - Phone:262-687-4479
Mailing Address - Fax:262-687-5375
Practice Address - Street 1:3801 SPRING ST
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-1667
Practice Address - Country:US
Practice Address - Phone:262-687-4201
Practice Address - Fax:262-687-5375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI52300Medicare ID - Type UnspecifiedMEDICARE NUMBER