| NPI | 1720283302 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GANESH N PULLA Doctor 262-564-8636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QE0700X Clinic/Center, End-Stage Renal Disease (ESRD) Treatment (Licence: WI 40695-20) |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2014-12-19 |