Provider Demographics
NPI:1891235263
Name:MMCW LLC
Entity Type:Organization
Organization Name:MMCW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MEURET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-254-2420
Mailing Address - Street 1:515 JUNCTION RD
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-2151
Mailing Address - Country:US
Mailing Address - Phone:314-254-2420
Mailing Address - Fax:314-787-2141
Practice Address - Street 1:515 JUNCTION RD
Practice Address - Street 2:SUITE 2100
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-2151
Practice Address - Country:US
Practice Address - Phone:314-254-2420
Practice Address - Fax:314-787-2141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty