Provider Demographics
NPI:1265659676
Name:RIVERSIDE GYNECOLOGY AND WOMEN'S HEALTHCARE
Entity Type:Organization
Organization Name:RIVERSIDE GYNECOLOGY AND WOMEN'S HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BARON-KUHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-446-6844
Mailing Address - Street 1:22099 DAVIDSON RD
Mailing Address - Street 2:203
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-4069
Mailing Address - Country:US
Mailing Address - Phone:262-446-6844
Mailing Address - Fax:630-665-3868
Practice Address - Street 1:22099 DAVIDSON RD
Practice Address - Street 2:203
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-4069
Practice Address - Country:US
Practice Address - Phone:262-446-6844
Practice Address - Fax:630-665-3868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46778207VH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D16528Medicare UPIN