Provider Demographics
NPI:1992863161
Name:PEDIATRIC AND ADULT MEDICINE ASSOCIATES S.C.
Entity Type:Organization
Organization Name:PEDIATRIC AND ADULT MEDICINE ASSOCIATES S.C.
Other - Org Name:PEDIATRIC HEALTH ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIOLETA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SINGSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-345-3000
Mailing Address - Street 1:535 N 27TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-4029
Mailing Address - Country:US
Mailing Address - Phone:414-345-3000
Mailing Address - Fax:414-345-3001
Practice Address - Street 1:535 N 27TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-4029
Practice Address - Country:US
Practice Address - Phone:414-345-3000
Practice Address - Fax:414-345-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32867800Medicaid