Basic Information
| Provider Information | |||||||||
| NPI: | 1669765020 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FROEDTERT PHYSICIAN PARTNERS, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FROEDTERT HEALTH SUSSEX CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | N74W12507 LEATHERWOOD CT | ||||||||
| Address2: | |||||||||
| City: | MENOMONEE FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530514490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4147770417 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | N64W24801 MAIN ST | ||||||||
| Address2: | STE 109 | ||||||||
| City: | SUSSEX | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530892652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2625328680 | ||||||||
| FaxNumber: | 2625328689 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2011 | ||||||||
| LastUpdateDate: | 10/06/2022 | ||||||||
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| AuthorizedOfficialLastName: | EASTHAM | ||||||||
| AuthorizedOfficialFirstName: | CATHERINE | ||||||||
| AuthorizedOfficialMiddleName: | MODE | ||||||||
| AuthorizedOfficialTitleorPosition: | SVP AND GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 4148052994 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FROEDTERT PHYSICIAN PARTNERS, INC. | ||||||||
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| NPICertificationDate: | 10/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.