Provider Demographics
NPI:1740309061
Name:MILWAUKEE CARDIOVASCULAR CNTR S.C.
Entity type:Organization
Organization Name:MILWAUKEE CARDIOVASCULAR CNTR S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:LEWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-672-7200
Mailing Address - Street 1:2778 S 35TH ST
Mailing Address - Street 2:#101
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3578
Mailing Address - Country:US
Mailing Address - Phone:414-672-7200
Mailing Address - Fax:414-672-7400
Practice Address - Street 1:2778 S 35TH ST
Practice Address - Street 2:#101
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3578
Practice Address - Country:US
Practice Address - Phone:414-672-7200
Practice Address - Fax:414-672-7400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31372000Medicaid
WI31372000Medicaid