Basic Information
| Provider Information | |||||||||
| NPI: | 1780959213 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL ON THE MOVE | ||||||||
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| Mailing Information | |||||||||
| Address1: | N85W18181 TYLER DR | ||||||||
| Address2: | |||||||||
| City: | MENOMONEE FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530512535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2622502570 | ||||||||
| FaxNumber: | 2622554090 | ||||||||
| Practice Location | |||||||||
| Address1: | N88W16624 APPLETON AVE | ||||||||
| Address2: | |||||||||
| City: | MENOMONEE FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530512858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2623455343 | ||||||||
| FaxNumber: | 2624371328 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2012 | ||||||||
| LastUpdateDate: | 03/16/2012 | ||||||||
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| AuthorizedOfficialLastName: | MISCHUK | ||||||||
| AuthorizedOfficialFirstName: | TRACY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2625012000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.