Provider Demographics
NPI:1528006277
Name:SHOREWOOD FAMILY PHYSICIANS S C
Entity Type:Organization
Organization Name:SHOREWOOD FAMILY PHYSICIANS S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETRUZATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-962-7477
Mailing Address - Street 1:1901 E CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2335
Mailing Address - Country:US
Mailing Address - Phone:414-962-7477
Mailing Address - Fax:414-962-2420
Practice Address - Street 1:1901 E CAPITOL DR
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-2335
Practice Address - Country:US
Practice Address - Phone:414-962-7477
Practice Address - Fax:414-962-2420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty