Provider Demographics
NPI:1295093235
Name:PHYSICAL MEDICINE INSTITUTE OF WISCONSIN
Entity type:Organization
Organization Name:PHYSICAL MEDICINE INSTITUTE OF WISCONSIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:RISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-200-2700
Mailing Address - Street 1:1370 PADST FARMS CIRCLE
Mailing Address - Street 2:SUITE 345
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4879
Mailing Address - Country:US
Mailing Address - Phone:262-200-2700
Mailing Address - Fax:
Practice Address - Street 1:1370 PADST FARMS CIRCLE
Practice Address - Street 2:SUITE 345
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-4879
Practice Address - Country:US
Practice Address - Phone:262-200-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2772820207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty