Provider Demographics
NPI:1942698212
Name:PRIMARY CARE OF MILWAUKEE, S.C.
Entity Type:Organization
Organization Name:PRIMARY CARE OF MILWAUKEE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GANAPES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-305-1334
Mailing Address - Street 1:2500 W LAYTON AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-5420
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 W LAYTON AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-5420
Practice Address - Country:US
Practice Address - Phone:414-305-1334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty