| NPI | 1912752569 |
|---|---|
| Other Name | TPAN |
| Entity Type | Organization |
| Authorized Contact | TANYA MAULDIN Provider Enrollment Manager 414-225-1611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2024-04-18 |
| Last Update Date | 2024-04-18 |