Provider Demographics
NPI:1639515000
Name:MILWAUKEE GI SPECIALISTS SC
Entity Type:Organization
Organization Name:MILWAUKEE GI SPECIALISTS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:KWECH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-908-6507
Mailing Address - Street 1:2801 W KINNICKINNIC RIVER PKWY STE 1080
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3689
Mailing Address - Country:US
Mailing Address - Phone:414-908-6615
Mailing Address - Fax:414-385-2980
Practice Address - Street 1:1033 N MAYFAIR RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3442
Practice Address - Country:US
Practice Address - Phone:414-454-0600
Practice Address - Fax:414-385-2980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty