| Carbon Health Medical Group Of Wisconsin Sc | |
|
11415 W Burleigh St Ste 103 Wauwatosa WI 53222-3217 | |
| (844) 234-7741 | |
| Not Available |
| Full Name | Carbon Health Medical Group Of Wisconsin Sc |
|---|---|
| Speciality | Family Medicine |
| Location | 11415 W Burleigh St Ste 103, Wauwatosa, Wisconsin |
| Authorized Official Name and Position | Kaitlin Boyle (DIRECTOR) |
| Authorized Official Contact | 3036015392 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carbon Health Medical Group Of Wisconsin Sc 2100 Franklin St Ste 355 Oakland CA 94612-3140 Ph: () - | Carbon Health Medical Group Of Wisconsin Sc 11415 W Burleigh St Ste 103 Wauwatosa WI 53222-3217 Ph: (844) 234-7741 |
| NPI Number | 1912616194 |
|---|---|
| Provider Enumeration Date | 11/16/2022 |
| Last Update Date | 07/16/2024 |
| Medicare PECOS PAC ID | 8426412099 |
|---|---|
| Medicare Enrollment ID | O20230914003415 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912616194 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Secondary |
| Provider Name | Matthew E Peters |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316224983 PECOS PAC ID: 1052578762 Enrollment ID: I20120208000629 |
| Provider Name | Sumeet K Goel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073824470 PECOS PAC ID: 2163663691 Enrollment ID: I20130726000147 |
| Provider Name | Sujal Mandavia |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1992791164 PECOS PAC ID: 0042204687 Enrollment ID: I20230914003580 |
| Provider Name | Arnold S Cruz |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1487682514 PECOS PAC ID: 6901878800 Enrollment ID: I20231108002912 |
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