Froedtert & the Medical College of Wisconsin Community Physicians

NPI #1780142992 in Mequon, Wisconsin

Provider Information

NPI Number: 1780142992
Entity Type: Organization
Organization Name: Froedtert & the Medical College of Wisconsin Community Physicians
Subpart: Yes (part of a larger organization)
Parent Organization: FROEDTERT & THE MEDICAL COLLEGE OF WISCONSIN COMMUNITY PHYSICIANS
Primary Specialty: Non-Pharmacy Dispensing Site
Enumeration Date: Mar 6, 2019
Last Updated: Mar 6, 2019

Practice Location

Address: 11040 N RANGE LINE RD
City: Mequon
State: Wisconsin
ZIP Code: 53092-4930
Phone: (262) 253-5230

Authorized Official

Name: RANDALL NEWMAN
Title: VP OF FINANCE
Phone: (414) 777-7963

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Non-Pharmacy Dispensing Site	332900000X	Primary

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