Basic Information
| Provider Information | |||||||||
| NPI: | 1528303377 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMBULATORY ANESTHESIA ASSOCIATES SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4555 W SCHROEDER DR | ||||||||
| Address2: | SUITE 170 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532231496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143653210 | ||||||||
| FaxNumber: | 4143653225 | ||||||||
| Practice Location | |||||||||
| Address1: | 10900 W POTTER RD | ||||||||
| Address2: | |||||||||
| City: | WAUWATOSA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532263424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4147749227 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2012 | ||||||||
| LastUpdateDate: | 01/09/2013 | ||||||||
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| AuthorizedOfficialLastName: | DOYLE | ||||||||
| AuthorizedOfficialFirstName: | MARYAM | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4145263046 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.