| Concordia University, Inc | |
|
12800 N Lake Shore Dr Mequon WI 53097-2418 | |
| (972) 367-4845 | |
| Not Available |
| Full Name | Concordia University, Inc |
|---|---|
| Speciality | General Practice |
| Location | 12800 N Lake Shore Dr, Mequon, Wisconsin |
| Authorized Official Name and Position | Mouzon Bass (ADMINISTRATOR/AGENT) |
| Authorized Official Contact | 9723674845 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Concordia University, Inc 5050 Spring Valley Rd Dallas TX 75244-3995 Ph: () - | Concordia University, Inc 12800 N Lake Shore Dr Mequon WI 53097-2418 Ph: (972) 367-4845 |
| NPI Number | 1518439843 |
|---|---|
| Provider Enumeration Date | 12/27/2018 |
| Last Update Date | 12/27/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518439843 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
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