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375 W River Woods Pkwy Glendale WI 53212-1080 | |
| (414) 326-1500 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | General Practice |
| Location | 375 W River Woods Pkwy, Glendale, Wisconsin |
| Authorized Official Name and Position | Michael Mccullough (CFO) |
| Authorized Official Contact | 4144653736 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
375 W River Woods Pkwy Glendale WI 53212-1080 Ph: (414) 326-1500 | 375 W River Woods Pkwy Glendale WI 53212-1080 Ph: (414) 326-1500 |
| NPI Number | 1194330712 |
|---|---|
| Provider Enumeration Date | 09/10/2020 |
| Last Update Date | 01/07/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194330712 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 208D00000X | General Practice | (* (Not Available)) | Primary |
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