Provider Demographics
NPI:1952447336
Name:MILWAUKEE DIGESTIVE DISEASE CONSULTANTS, S.C.
Entity Type:Organization
Organization Name:MILWAUKEE DIGESTIVE DISEASE CONSULTANTS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:HIETPAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-649-3418
Mailing Address - Street 1:2901 W. KK RIVER PKWY.
Mailing Address - Street 2:SUITE 414
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3660
Mailing Address - Country:US
Mailing Address - Phone:414-649-3750
Mailing Address - Fax:414-649-3411
Practice Address - Street 1:2901 W. KK RIVER PKWY.
Practice Address - Street 2:SUITE 414
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3660
Practice Address - Country:US
Practice Address - Phone:414-649-3750
Practice Address - Fax:414-649-3411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B54158Medicare UPIN
B57505Medicare UPIN
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S52491Medicare UPIN
C78363Medicare UPIN
B51576Medicare UPIN
B53395Medicare UPIN
A03658Medicare UPIN
S88390Medicare UPIN
B54668Medicare UPIN
F70832Medicare UPIN