Provider Demographics
NPI:1831413723
Name:MILWAUKEE KIDNEY INSTITUTE INC
Entity type:Organization
Organization Name:MILWAUKEE KIDNEY INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:CAREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-820-1012
Mailing Address - Street 1:W269N6980 HICKORY CHASM CT
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-2351
Mailing Address - Country:US
Mailing Address - Phone:262-820-1012
Mailing Address - Fax:
Practice Address - Street 1:2400 GOLF RD
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-5590
Practice Address - Country:US
Practice Address - Phone:262-524-2771
Practice Address - Fax:262-524-2797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-21
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty