| Allegiance Internal Medicine Specialists, Sc | |
|
2645 N Mayfair Rd Ste 200 Wauwatosa WI 53226-1304 | |
| (414) 479-1800 | |
| (414) 479-1813 |
| Full Name | Allegiance Internal Medicine Specialists, Sc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2645 N Mayfair Rd Ste 200, Wauwatosa, Wisconsin |
| Authorized Official Name and Position | Andrew C Kim (PRESIDENT) |
| Authorized Official Contact | 4144791800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Allegiance Internal Medicine Specialists, Sc 2645 N Mayfair Rd Ste 200 Wauwatosa WI 53226-1304 Ph: (414) 479-1800 | Allegiance Internal Medicine Specialists, Sc 2645 N Mayfair Rd Ste 200 Wauwatosa WI 53226-1304 Ph: (414) 479-1800 |
| NPI Number | 1699808196 |
|---|---|
| Provider Enumeration Date | 03/13/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 7517156433 |
|---|---|
| Medicare Enrollment ID | O20110107000674 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699808196 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (Wisconsin) | Primary |
| Provider Name | Andrew C Kim |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184697625 PECOS PAC ID: 0345152674 Enrollment ID: I20100818000687 |
| Provider Name | Samuel H Idarraga |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700850070 PECOS PAC ID: 2769671346 Enrollment ID: I20110502000368 |
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