| NPI | 1649405564 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL N MANGOLD President/Owner 262-338-8100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WI 32859) |
| Enumeration Date | 2009-05-20 |
| Last Update Date | 2011-09-01 |