| Impact Physician Group, Wisconsin Llc | |
|
3200 S 103rd St Milwaukee WI 53227-4104 | |
| (469) 640-6500 | |
| Not Available |
| Full Name | Impact Physician Group, Wisconsin Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3200 S 103rd St, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Paul Miller (CEO) |
| Authorized Official Contact | 6789675599 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Impact Physician Group, Wisconsin Llc 21 Eastbrook Bnd Ste 218 Peachtree City GA 30269-1546 Ph: (678) 967-5599 | Impact Physician Group, Wisconsin Llc 3200 S 103rd St Milwaukee WI 53227-4104 Ph: (469) 640-6500 |
| NPI Number | 1174291025 |
|---|---|
| Provider Enumeration Date | 09/03/2021 |
| Last Update Date | 12/19/2022 |
| Medicare PECOS PAC ID | 2466840004 |
|---|---|
| Medicare Enrollment ID | O20211101000625 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174291025 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Turgut Z Zia |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699783894 PECOS PAC ID: 6204804396 Enrollment ID: I20040916001234 |
| Provider Name | Mansoor Hussain Mirza |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508974502 PECOS PAC ID: 3072549021 Enrollment ID: I20050712000423 |
| Provider Name | Kamran Quraishi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417175068 PECOS PAC ID: 0648361568 Enrollment ID: I20070807000699 |
| Provider Name | Chukwuma E Ugwu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457666315 PECOS PAC ID: 0749420636 Enrollment ID: I20130718000047 |
| Provider Name | Krishna Kottapalli |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952678286 PECOS PAC ID: 4486888484 Enrollment ID: I20131007000296 |
| Provider Name | Wamiq Y Banday |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659520229 PECOS PAC ID: 5193870327 Enrollment ID: I20140812001967 |
| Provider Name | Nicholas Otten |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013277714 PECOS PAC ID: 2264651108 Enrollment ID: I20150806010351 |
| Provider Name | Tesfaye H Gebremedhin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780927657 PECOS PAC ID: 5799077483 Enrollment ID: I20160718001163 |
| Provider Name | Ashley M Weiland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841842697 PECOS PAC ID: 6800299124 Enrollment ID: I20210724000074 |
| Provider Name | Yasir Yafai |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1205395381 PECOS PAC ID: 8224417357 Enrollment ID: I20220621002161 |
| Provider Name | Jessica Denton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003599507 PECOS PAC ID: 5597113589 Enrollment ID: I20231201000715 |
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