Prohealth Medical Group Inc
Legal Business Name
Prohealth Medical Group Inc
NPI Number
1114966231
NPI Type
Organization
Enumeration Date
06/05/2006
Specialties
(Taxonomies)Name
Code
207K00000X
207N00000X
207Q00000X
2084N0400X
207V00000X
207X00000X
207Y00000X
208000000X
104100000X
Primary Taxonomy
No
No
No
No
No
No
No
No
No
Contact
Information
Purpose
Mailing
Location
Address
725 AMERICAN AVE
N16W24131 RIVERWOOD DR
City
Waukesha
Waukesha
State
WI
WI
Postal Code
53188-5031
53188-1106
Country
US
US
Telephone Number
(262) 928-3270
(262) 696-0808
Authorized Official
Name
Brian Lipman
Title or Position
PRESIDENT CLINIC DIVISION
Telephone Number
(262) 928-8669
Identifiers
Identifier
0505180015
Identifier State
WI
Identifier Issuer
DME
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 05/23/2022