1225476740 NPI number — FROEDTERT & THE MEDICAL COLLEGE OF WISCONSIN COMMUNITY PHYSICIANS INC

Table of content: (NPI 1225476740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225476740 NPI number — FROEDTERT & THE MEDICAL COLLEGE OF WISCONSIN COMMUNITY PHYSICIANS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FROEDTERT & THE MEDICAL COLLEGE OF WISCONSIN COMMUNITY PHYSICIANS INC
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:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225476740
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 WOODLAND PRIME, SUITE 103
Provider Second Line Business Mailing Address:
N74 W12501 LEATHERWOOD CT
Provider Business Mailing Address City Name:
MENOMONEE FALLS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53051-4490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-777-0417
Provider Business Mailing Address Fax Number:
414-777-0096

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 W PARADISE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST BEND
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53095-9795
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-334-3451
Provider Business Practice Location Address Fax Number:
262-334-5321
Provider Enumeration Date:
06/06/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GHAFERI
Authorized Official First Name:
AMIR
Authorized Official Middle Name:
ABBAS
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
734-660-4939

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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