Provider Demographics
NPI:1356321715
Name:AMERIPATH MILWAUKEE SC
Entity Type:Organization
Organization Name:AMERIPATH MILWAUKEE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-550-3000
Mailing Address - Street 1:14275 MIDWAY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:707 S UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-3027
Practice Address - Country:US
Practice Address - Phone:920-887-7181
Practice Address - Fax:414-476-2975
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERIPATH INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-20
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32812800Medicaid
WI52D0391842OtherCLIA
WI32812700Medicaid
WI32869100Medicaid
WI52D1004935OtherCLIA
WI52D0390963OtherCLIA
WI52D1019615OtherCLIA
WI52D0397949OtherCLIA
WI52D0662006OtherCLIA
WI32868900Medicaid
WV32869000Medicaid
WI52D0388186OtherCLIA
WI52D0390458OtherCLIA
WI52D0390963OtherCLIA
WI52D0391842OtherCLIA
WI52D0388186OtherCLIA
WI32812800Medicaid
WI16245Medicare PIN