1467564682 NPI number — RAWSON FAMILY MEDICINE WEIGHT MANAGEMENT CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467564682 NPI number — RAWSON FAMILY MEDICINE WEIGHT MANAGEMENT CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAWSON FAMILY MEDICINE WEIGHT MANAGEMENT CENTER
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:
1467564682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
N87W16462 JACOBSON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MENOMONEE FALLS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53051-2833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-255-1040
Provider Business Mailing Address Fax Number:
262-255-4090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2603 W RAWSON AVE STE 108
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK CREEK
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53154-8422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-431-6990
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PAREKH
Authorized Official First Name:
MADHAVI
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
414-431-6991

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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