| NPI | 1245490127 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANGELA M POOLE Chief Financial Officer 414-934-7582 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 49433) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 4109) |
| 363A00000X Physician Assistant (Licence: WI 2023) | |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2008-06-13 |