Provider Demographics
NPI:1306016654
Name:RHEUMATOLOGY AND IMMUNOTHERAPY CENTER
Entity Type:Organization
Organization Name:RHEUMATOLOGY AND IMMUNOTHERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-768-0940
Mailing Address - Street 1:200 E RYAN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-4533
Mailing Address - Country:US
Mailing Address - Phone:414-768-0940
Mailing Address - Fax:
Practice Address - Street 1:7401 104TH AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142
Practice Address - Country:US
Practice Address - Phone:414-768-0940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46013207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIG90894Medicare UPIN
WI000001437Medicare PIN