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Specialty details in registry · Milwaukee, WI

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At a glance

2801 W Kinnickinnic River Pkwy Ste 445, Milwaukee, WI 53215-3669

NPPES record updated May 11, 2020. Public records can lag behind changes at a practice.

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Practice location

2801 W Kinnickinnic River Pkwy Ste 445
Milwaukee, WI 53215-3669
Professional details: NPI, taxonomy & registry record
NPI1790307080
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Registry details

Primary taxonomy
Specialty details in registry
Taxonomy code
207RP1001X
Enumeration date
May 11, 2020
Record updated
May 11, 2020
More registry details
Provider type
Organization · Type 2

Reported taxonomies and licenses

Specialty details in registry

207RP1001X · Primary

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

2801 W Kinnickinnic River Pkwy Ste 445
Milwaukee, WI 53215-3669
Phone
(414) 649-5288
Fax
(414) 649-5875
Mailing address
6400 INDUSTRIAL LOOP

GREENDALE, WI 531292452
Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.

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