# PREMIER CARDIOVASCULAR INSTITUTE OF WISCONSIN LLC

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

## Provider details

- **NPI number:** 1104222330
- **Authorized official:** DR. OBRAD KOKANOVIC M.D. (OWNER)
- **Authorized official phone:** (406) 750-8202

## Contact information

- **Practice address:** 1309 S 54TH ST, MILWAUKEE, WI 53214-3404
- **Practice address phone:** (406) 750-8202
- **Mailing address:** 2500 W LAYTON AVE, SUITE 200, MILWAUKEE, WI 53221-5420
- **Mailing address phone:** (406) 750-8202

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 51767 | WI | Yes |

## Other

- **Enumeration date:** 11/17/2014
- **Last updated:** 01/27/2015