Provider Demographics
NPI:1336359926
Name:BROOKFIELD HEART AND VASCULAR
Entity Type:Organization
Organization Name:BROOKFIELD HEART AND VASCULAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:K
Authorized Official - Last Name:ASHPOLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-266-9740
Mailing Address - Street 1:PO BOX 341353
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53234-1353
Mailing Address - Country:US
Mailing Address - Phone:262-785-1500
Mailing Address - Fax:414-785-3828
Practice Address - Street 1:17000 W NORTH AVE
Practice Address - Street 2:SUITE 104-W
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4423
Practice Address - Country:US
Practice Address - Phone:262-785-1500
Practice Address - Fax:414-785-3828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21275600Medicaid
WI21275600Medicaid