| NPI | 1518423995 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL MCCULLOUGH CFO 414-465-3736 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261QR0400X Clinic/Center Rehabilitation |
| 261QX0200X Clinic/Center Oncology | |
| Enumeration Date | 2019-02-11 |
| Last Update Date | 2025-01-07 |