Provider Demographics
NPI:1780959213
Name:MEDICAL ON THE MOVE
Entity type:Organization
Organization Name:MEDICAL ON THE MOVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MISCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-501-2000
Mailing Address - Street 1:N85W18181 TYLER DR
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-2535
Mailing Address - Country:US
Mailing Address - Phone:262-250-2570
Mailing Address - Fax:262-255-4090
Practice Address - Street 1:N88W16624 APPLETON AVE
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-2858
Practice Address - Country:US
Practice Address - Phone:262-345-5343
Practice Address - Fax:262-437-1328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty