Provider Demographics
NPI:1487627865
Name:MILWAUKEE OBSTETRICS & GYNECOLOGY, S.C.
Entity Type:Organization
Organization Name:MILWAUKEE OBSTETRICS & GYNECOLOGY, S.C.
Other - Org Name:MILWAUKEE OBSTETRICS & GYNECOLOGY SC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D./PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-476-0306
Mailing Address - Street 1:2457 N MAYFAIR RD
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226
Mailing Address - Country:US
Mailing Address - Phone:414-476-0306
Mailing Address - Fax:414-476-7720
Practice Address - Street 1:2457 N MAYFAIR RD
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226
Practice Address - Country:US
Practice Address - Phone:414-476-0306
Practice Address - Fax:414-476-7720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27125207V00000X
WI29585207V00000X
WI43777207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WICO1045OtherRAILROAD MEDICARE
WI000073823Medicare PIN