| NPI | 1437731585 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID B TICK Owner 414-645-6665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2021-04-27 |
| Last Update Date | 2021-04-27 |