Provider Demographics
NPI:1932288784
Name:ENT SPECIALISTS OF MILWAUKEE, S.C.
Entity Type:Organization
Organization Name:ENT SPECIALISTS OF MILWAUKEE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIX
Authorized Official - Suffix:
Authorized Official - Credentials:MBS
Authorized Official - Phone:414-434-0266
Mailing Address - Street 1:8532 W CAPITOL DR
Mailing Address - Street 2:L1OO
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1827
Mailing Address - Country:US
Mailing Address - Phone:414-434-0266
Mailing Address - Fax:414-536-7001
Practice Address - Street 1:8532 W CAPITOL DR
Practice Address - Street 2:L1OO
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1827
Practice Address - Country:US
Practice Address - Phone:414-434-0266
Practice Address - Fax:414-536-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21287800Medicaid
WI000073031Medicare ID - Type Unspecified