Provider Demographics
NPI:1134211642
Name:GENERAL & VASCULAR SURGEONS, S.C.
Entity type:Organization
Organization Name:GENERAL & VASCULAR SURGEONS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-328-8080
Mailing Address - Street 1:2424 S 90TH ST
Mailing Address - Street 2:STE 208
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2455
Mailing Address - Country:US
Mailing Address - Phone:414-328-8080
Mailing Address - Fax:414-328-8084
Practice Address - Street 1:2424 S 90TH ST
Practice Address - Street 2:STE 208
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2455
Practice Address - Country:US
Practice Address - Phone:414-328-8080
Practice Address - Fax:414-328-8084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI160942086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32866400Medicaid
WI02090Medicare ID - Type Unspecified