1356586481 NPI number — EDWARD WOLPERT MD SC LTD

Table of content: (NPI 1356586481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356586481 NPI number — EDWARD WOLPERT MD SC LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDWARD WOLPERT MD SC LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356586481
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
E7560 TROY VILLAGE RD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING GREEN
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53588
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-588-2600
Provider Business Mailing Address Fax Number:
608-588-2644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
156 W JEFFERSON
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING GREEN
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-588-2600
Provider Business Practice Location Address Fax Number:
608-588-2644
Provider Enumeration Date:
12/03/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WOLPERT
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
608-588-7173

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  071002659 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 18657020 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0800X , with the licence number: 03637375 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)