| NPI | 1386042075 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARREN MATAVKA Executive Vice President 414-301-6383 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363LA2200X Nurse Practitioner, Adult Health | |
| Enumeration Date | 2014-12-11 |
| Last Update Date | 2014-12-11 |