Organization

Prohealth Medical Group Inc

Legal Business Name

Prohealth Medical Group Inc

NPI Number

1114966231

NPI Type

Organization

Enumeration Date

06/05/2006

Specialties

(Taxonomies)

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

Provider Address