Provider Demographics
NPI:1487848743
Name:MIDWEST NEPHROLOGY ASSOCIATES, S.C.
Entity Type:Organization
Organization Name:MIDWEST NEPHROLOGY ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:V
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-762-2020
Mailing Address - Street 1:111 ANN STREET
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5163
Mailing Address - Country:US
Mailing Address - Phone:262-542-6179
Mailing Address - Fax:262-542-6182
Practice Address - Street 1:111 ANN STREET
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5163
Practice Address - Country:US
Practice Address - Phone:262-542-6179
Practice Address - Fax:262-542-6182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty