Provider Demographics
NPI:1891799755
Name:UROLOGY SPECIALISTS S.C.
Entity Type:Organization
Organization Name:UROLOGY SPECIALISTS S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:WIATRAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-527-3000
Mailing Address - Street 1:2350 W VILLARD AVE
Mailing Address - Street 2:STE 301
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-5084
Mailing Address - Country:US
Mailing Address - Phone:414-527-3000
Mailing Address - Fax:414-527-3114
Practice Address - Street 1:2350 W VILLARD AVE
Practice Address - Street 2:STE 301
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-5084
Practice Address - Country:US
Practice Address - Phone:414-527-3000
Practice Address - Fax:414-527-3114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31968174400000X
WI37739174400000X
WI45820174400000X
WI457-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3172800Medicaid
WI32233400Medicaid
WI34422300Medicaid
WI42912700Medicaid
WI01065Medicare ID - Type UnspecifiedENSOR
WI01065Medicare ID - Type UnspecifiedDR. SANDOCK
WIH17061Medicare UPIN
WI01065Medicare ID - Type UnspecifiedDR. WIATRAK
WI42912700Medicaid
WI32233400Medicaid
WIE85808Medicare UPIN
WI01065Medicare ID - Type UnspecifiedDR. BANDA