Basic Information
Provider Information
NPI: 1790718237
EntityType: 2
ReplacementNPI:  
OrganizationName: CARDIOVASCULAR SURGERY ASSOCIATES S.C.
LastName:  
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Credential:  
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Mailing Information
Address1: 2901 W KINNICKINNIC RIVER PKWY
Address2: SUITE #310
City: MILWAUKEE
State: WI
PostalCode: 532153677
CountryCode: US
TelephoneNumber: 4146493990
FaxNumber: 4146493969
Practice Location
Address1: 2901 W KINNICKINNIC RIVER PKWY
Address2: SUITE #310
City: MILWAUKEE
State: WI
PostalCode: 532153677
CountryCode: US
TelephoneNumber: 4146493990
FaxNumber: 4146493969
Other Information
ProviderEnumerationDate: 07/08/2006
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
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ProviderGenderCode:  
AuthorizedOfficialLastName: WERNER
AuthorizedOfficialFirstName: PAUL
AuthorizedOfficialMiddleName: HERBERT
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 4146493990
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: M.D.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208G00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery) 

ID Information
IDTypeStateIssuerDescription
3273510005WI MEDICAID


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