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Organization
AFFILIATED HEALTH OF WISCONSIN LTD.
Active
Organization
AFFILIATED HEALTH OF WISCONSIN LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAY L MACKMAN DDS (DIRECTOR)
(414) 476-9400
Entity
Organization
Contact information
Practice address
2626 N 76TH ST, SUITE 105, WAUWATOSA, WI 53213-1137
(414) 774-7794
(414) 607-3971
Mailing address
2626 N 76TH ST, SUITE 105, WAUWATOSA, WI 53213-1137
(414) 774-7794
(414) 607-3971
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
NULL
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
—
225100000X
Physical Therapist
—
NULL
225100000X
Physical Therapist
—
—
2471C3401X
Computed Tomography Radiologic Technologist
—
NULL
2471C3401X
Computed Tomography Radiologic Technologist
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
Other
Enumeration date
07/23/2006
Last updated
08/25/2023
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