# OZAUKEE MEDICAL GROUP, LLC

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

## Provider details

- **NPI number:** 1326125469
- **Authorized official:** DR. BRUCE C HERMAN M.D. (MANAGER)
- **Authorized official phone:** (262) 242-3000

## Contact information

- **Practice address:** 407 N MAIN ST, THIENSVILLE, WI 53092-1212
- **Practice address phone:** (262) 242-3000
- **Practice address fax:** (262) 242-7191
- **Mailing address:** 407 N MAIN ST, THIENSVILLE, WI 53092-1212
- **Mailing address phone:** (262) 242-3000
- **Mailing address fax:** (262) 242-7191

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 21717 | WI | Yes |

## Other

- **Enumeration date:** 11/01/2006
- **Last updated:** 10/11/2010