1336359926 NPI number — BROOKFIELD HEART AND VASCULAR

Table of content: (NPI 1336359926)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336359926 NPI number — BROOKFIELD HEART AND VASCULAR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROOKFIELD HEART AND VASCULAR
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:
1336359926
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 341353
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53234-1353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-785-1500
Provider Business Mailing Address Fax Number:
414-785-3828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17000 W NORTH AVE
Provider Second Line Business Practice Location Address:
SUITE 104-W
Provider Business Practice Location Address City Name:
BROOKFIELD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53005-4423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-785-1500
Provider Business Practice Location Address Fax Number:
414-785-3828
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ASHPOLE
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
414-266-9740

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 21275600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com