Provider Demographics
NPI:1528369469
Name:DAVID E. AMOS MDSC
Entity Type:Organization
Organization Name:DAVID E. AMOS MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ESPEJO
Authorized Official - Last Name:AMOS
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:414-444-7787
Mailing Address - Street 1:5800 W BURLEIGH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1516
Mailing Address - Country:US
Mailing Address - Phone:414-444-7787
Mailing Address - Fax:414-831-0335
Practice Address - Street 1:5800 W BURLEIGH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1516
Practice Address - Country:US
Practice Address - Phone:414-444-7787
Practice Address - Fax:414-831-0335
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID E. AMOS M.D.S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-09
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20543207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30901500Medicaid
WI30901500Medicaid
WIB84657Medicare UPIN