| NPI | 1598188542 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARREN MATAVKA Executive Vice President 414-301-6381 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| 363LF0000X Nurse Practitioner, Family | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2014-01-28 |
| Last Update Date | 2014-01-28 |