Basic Information
| Provider Information | |||||||||
| NPI: | 1396193033 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW BERLIN MEDICAL SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8153 S 27TH ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | FRANKLIN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531329549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143045311 | ||||||||
| FaxNumber: | 4147611614 | ||||||||
| Practice Location | |||||||||
| Address1: | 15324 W BELOIT ROAD | ||||||||
| Address2: | |||||||||
| City: | NEW BERLIN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4147610981 | ||||||||
| FaxNumber: | 4147611614 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2016 | ||||||||
| LastUpdateDate: | 06/02/2016 | ||||||||
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| AuthorizedOfficialLastName: | MATTEUCCI | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | DONALD | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4147610981 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | SR. | ||||||||
| AuthorizedOfficialCredential: | D.P.M. | ||||||||
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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.