# IMPACT PHYSICIAN GROUP, WISCONSIN LLC

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

## Provider details

- **NPI number:** 1174291025
- **Authorized official:** PAUL MILLER (CEO)
- **Authorized official phone:** (678) 967-5599

## Contact information

- **Practice address:** 3200 S 103RD ST, MILWAUKEE, WI 53227-4104
- **Practice address phone:** (469) 640-6500
- **Mailing address:** 21 EASTBROOK BND STE 218, PEACHTREE CITY, GA 30269-1546
- **Mailing address phone:** (678) 967-5599

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/03/2021
- **Last updated:** 12/19/2022