Provider Demographics
NPI:1659666378
Name:STAUDACHER CARDIOLOGY SERVICES, SC
Entity Type:Organization
Organization Name:STAUDACHER CARDIOLOGY SERVICES, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:STAUDACHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-227-6589
Mailing Address - Street 1:721 AMERICAN AVE
Mailing Address - Street 2:SUITE 411
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5071
Mailing Address - Country:US
Mailing Address - Phone:262-896-4608
Mailing Address - Fax:262-896-4643
Practice Address - Street 1:721 AMERICAN AVE
Practice Address - Street 2:SUITE 411
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5071
Practice Address - Country:US
Practice Address - Phone:262-896-4608
Practice Address - Fax:262-896-4643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-10
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31083-20207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty