Basic Information
| Provider Information | |||||||||
| NPI: | 1639515000 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MILWAUKEE GI SPECIALISTS SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2801 W KINNICKINNIC RIVER PKWY STE 1080 | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532153689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4149086615 | ||||||||
| FaxNumber: | 4143852980 | ||||||||
| Practice Location | |||||||||
| Address1: | 1033 N MAYFAIR RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | WAUWATOSA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532263442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144540600 | ||||||||
| FaxNumber: | 4143852980 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2013 | ||||||||
| LastUpdateDate: | 10/25/2020 | ||||||||
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| AuthorizedOfficialLastName: | KWECH | ||||||||
| AuthorizedOfficialFirstName: | BOB | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4149086507 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.