Provider Demographics
NPI:1770862054
Name:ALEX COLQUE, M.D. S.C.
Entity Type:Organization
Organization Name:ALEX COLQUE, M.D. S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:P
Authorized Official - Last Name:COLQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-781-9000
Mailing Address - Street 1:21675 E MORELAND BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186
Mailing Address - Country:US
Mailing Address - Phone:262-781-9000
Mailing Address - Fax:262-395-4068
Practice Address - Street 1:21675 E MORELAND BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186
Practice Address - Country:US
Practice Address - Phone:262-781-9000
Practice Address - Fax:262-395-4068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI55219020208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty