| Heritage Clinic S.c. | |
|
201 N Mayfair Rd Suite 535 Wauwatosa WI 53226-4216 | |
| (414) 771-6020 | |
| (414) 771-2242 |
| Full Name | Heritage Clinic S.c. |
|---|---|
| Speciality | Clinic/center |
| Location | 201 N Mayfair Rd, Wauwatosa, Wisconsin |
| Authorized Official Name and Position | Raymond Paul Mager (PRESIDENT) |
| Authorized Official Contact | 4147716020 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Heritage Clinic S.c. 9449 N Broadmoor Rd Bayside WI 53217-1310 Ph: (414) 771-6020 | Heritage Clinic S.c. 201 N Mayfair Rd Suite 535 Wauwatosa WI 53226-4216 Ph: (414) 771-6020 |
| NPI Number | 1588736276 |
|---|---|
| Provider Enumeration Date | 11/15/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588736276 | NPI | - | NPPES |
| 30032400 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 19290 (Wisconsin) | Primary |
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