Provider Demographics
NPI:1831461326
Name:PADRE PIO PEDIATRICS LLC
Entity Type:Organization
Organization Name:PADRE PIO PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:N
Authorized Official - Last Name:HASNAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-873-9800
Mailing Address - Street 1:929 W MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-3534
Mailing Address - Country:US
Mailing Address - Phone:414-384-6612
Mailing Address - Fax:414-384-6613
Practice Address - Street 1:929 W MITCHELL ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-3534
Practice Address - Country:US
Practice Address - Phone:262-945-4170
Practice Address - Fax:800-208-2413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43966-020261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34152600Medicaid
WI34152600Medicaid