Basic Information
| Provider Information | |||||||||
| NPI: | 1770633042 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALWIN | ||||||||
| FirstName: | SEAN | ||||||||
| MiddleName: | P.L.P. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1305 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WHITEWATER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531901503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2624734548 | ||||||||
| FaxNumber: | 2624727691 | ||||||||
| Practice Location | |||||||||
| Address1: | 1305 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WHITEWATER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531901503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2624734548 | ||||||||
| FaxNumber: | 2624727691 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2007 | ||||||||
| LastUpdateDate: | 07/23/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 26087 | WI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 26087-20 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 31402600 | 05 | WI | MEDICAID |