| Midwest Infectious Disease | |
|
2900 W Oklahoma Ave Milwaukee WI 53215-4330 | |
| (414) 649-3872 | |
| (414) 375-0192 |
| Full Name | Midwest Infectious Disease |
|---|---|
| Speciality | Internal Medicine |
| Location | 2900 W Oklahoma Ave, Milwaukee, Wisconsin |
| Authorized Official Name and Position | John C Christianson (PRESIDENT) |
| Authorized Official Contact | 4146493872 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Midwest Infectious Disease 1210 S James St Brookfield WI 53005-7191 Ph: (414) 649-3872 | Midwest Infectious Disease 2900 W Oklahoma Ave Milwaukee WI 53215-4330 Ph: (414) 649-3872 |
| NPI Number | 1174822480 |
|---|---|
| Provider Enumeration Date | 03/25/2011 |
| Last Update Date | 03/29/2011 |
| Medicare PECOS PAC ID | 6204011240 |
|---|---|
| Medicare Enrollment ID | O20110506000153 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174822480 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | 27387-20 (Wisconsin) | Primary |
| Provider Name | John C Christianson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114021151 PECOS PAC ID: 1951203736 Enrollment ID: I20040122000677 |
| Provider Name | Kathryn K Valukas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407129893 PECOS PAC ID: 9234392481 Enrollment ID: I20120525000215 |
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