Provider Demographics
NPI:1659747194
Name:MILWAUKEE MEDICAL WEIGHT LOSS & MEDISPA, INC.
Entity Type:Organization
Organization Name:MILWAUKEE MEDICAL WEIGHT LOSS & MEDISPA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMANUJAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-616-3535
Mailing Address - Street 1:8575 W FOREST HOME AVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-3469
Mailing Address - Country:US
Mailing Address - Phone:414-616-3535
Mailing Address - Fax:414-427-6338
Practice Address - Street 1:8575 W FOREST HOME AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-3469
Practice Address - Country:US
Practice Address - Phone:414-616-3535
Practice Address - Fax:414-427-6338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6307-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty