1295784072 NPI number — INFINITY HEALTHCARE PHYSICIANS, S.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295784072 NPI number — INFINITY HEALTHCARE PHYSICIANS, S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INFINITY HEALTHCARE PHYSICIANS, S.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295784072
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 E WISCONSIN AVE
Provider Second Line Business Mailing Address:
SUITE 2000
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53202-4815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-290-6718
Provider Business Mailing Address Fax Number:
414-290-6755

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ST. JOSEPH'S COMMUNITY HOSPITAL
Provider Second Line Business Practice Location Address:
3200 PLEASANT VALLEY ROAD
Provider Business Practice Location Address City Name:
WEST BEND
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53095-9274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-290-6718
Provider Business Practice Location Address Fax Number:
414-290-6755
Provider Enumeration Date:
05/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KONDAS
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICER
Authorized Official Telephone Number:
954-838-2371

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 369450303 . This is a "OWCP" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: CD4252 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 110008982 . This is a "WEA" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 32851400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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