# AFFILIATED HEALTH OF WISCONSIN LTD.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063433977
- **Authorized official:** JAY L MACKMAN DDS (DIRECTOR)
- **Authorized official phone:** (414) 476-9400

## Contact information

- **Practice address:** 2626 N 76TH ST, SUITE 105, WAUWATOSA, WI 53213-1137
- **Practice address phone:** (414) 774-7794
- **Practice address fax:** (414) 607-3971
- **Mailing address:** 2626 N 76TH ST, SUITE 105, WAUWATOSA, WI 53213-1137
- **Mailing address phone:** (414) 774-7794
- **Mailing address fax:** (414) 607-3971

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | Yes |
| 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