Children's Hospital of Wisconsin

NPI #1194064865 in Racine, Wisconsin

Provider Information

NPI Number: 1194064865
Entity Type: Organization
Organization Name: Children's Hospital of Wisconsin
Primary Specialty: Pediatrics
Enumeration Date: Jan 31, 2013
Last Updated: Sep 27, 2013

Practice Location

Address: 2405 NORTHWESTERN AVE
Address 2: SUITE 205
City: Racine
State: Wisconsin
ZIP Code: 53404-2534
Phone: (262) 898-7970

Authorized Official

Name: WELDON GAGE
Title: CREDENTIALING COORDINATOR
Phone: (414) 266-6401

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pediatrics	208000000X	Primary

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