Provider Demographics
NPI:1497712145
Name:PHYSICIANS OF OBSTETRICS & GYNECOLOGY LTD
Entity Type:Organization
Organization Name:PHYSICIANS OF OBSTETRICS & GYNECOLOGY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL STAFF ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-409-1004
Mailing Address - Street 1:7400 W RAWSON AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132
Mailing Address - Country:US
Mailing Address - Phone:414-409-1000
Mailing Address - Fax:414-409-1019
Practice Address - Street 1:7400 W. RAWSON AVE.
Practice Address - Street 2:SUITE 120
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132
Practice Address - Country:US
Practice Address - Phone:414-409-1000
Practice Address - Fax:414-409-1019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000001755Medicare ID - Type Unspecified