Provider Demographics
NPI:1275976979
Name:ACCENTCARE MEDICAL GROUP OF WISCONSIN, S.C.
Entity Type:Organization
Organization Name:ACCENTCARE MEDICAL GROUP OF WISCONSIN, S.C.
Other - Org Name:SEASONS MEDICAL GROUP OF WISCONSIN, SC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-692-1148
Mailing Address - Street 1:6400 SHAFER CT STE 300A
Mailing Address - Street 2:
Mailing Address - City:ROSEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60018-4914
Mailing Address - Country:US
Mailing Address - Phone:847-692-1000
Mailing Address - Fax:224-532-2780
Practice Address - Street 1:6737 W WASHINGTON ST
Practice Address - Street 2:STE 2150
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-5647
Practice Address - Country:US
Practice Address - Phone:800-379-5105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-11
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty