| NPI | 1609502707 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NAN NELSON Assistant Treasurer 414-219-1610 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2022-07-29 |
| Last Update Date | 2023-10-03 |