Provider Demographics
NPI:1255535324
Name:MILWAUKEE UROLOGICAL SC
Entity type:Organization
Organization Name:MILWAUKEE UROLOGICAL SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-961-7323
Mailing Address - Street 1:2015 E NEWPORT AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2984
Mailing Address - Country:US
Mailing Address - Phone:414-961-7323
Mailing Address - Fax:414-964-6445
Practice Address - Street 1:2015 E NEWPORT AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-2984
Practice Address - Country:US
Practice Address - Phone:414-961-7323
Practice Address - Fax:414-964-6445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1710975289OtherNPI
WI32009700Medicaid
WI1396732806OtherNPI
WI32675600Medicaid
WI1891788113OtherNPI
WI32675600Medicaid
WIH01386Medicare UPIN
WI1396732806OtherNPI