| NPI | 1285018630 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARREN MATAVKA Vice President 414-376-5577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2015-07-16 |
| Last Update Date | 2015-07-16 |