Provider Demographics
NPI:1750561874
Name:WISCONSIN HEART AND VASCULAR CLINICS SC
Entity type:Organization
Organization Name:WISCONSIN HEART AND VASCULAR CLINICS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
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:414-778-7790
Mailing Address - Street 1:601 N 99TH ST
Mailing Address - Street 2:SUITE #201
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4339
Mailing Address - Country:US
Mailing Address - Phone:414-778-7790
Mailing Address - Fax:414-476-8253
Practice Address - Street 1:601 N 99TH ST
Practice Address - Street 2:SUITE #201
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-4339
Practice Address - Country:US
Practice Address - Phone:414-778-7790
Practice Address - Fax:414-476-8253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32759400Medicaid
WI02365Medicare PIN