Basic Information
| Provider Information | |||||||||
| NPI: | 1104811918 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH SHORE SURGICAL CENTER A WI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7007 N RANGE LINE RD | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532092620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143523341 | ||||||||
| FaxNumber: | 4142474588 | ||||||||
| Practice Location | |||||||||
| Address1: | 7007 N RANGE LINE RD | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532092620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143523341 | ||||||||
| FaxNumber: | 4142474588 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KOWALSKI | ||||||||
| AuthorizedOfficialFirstName: | HELGA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2625327009 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.