# PHYSICIAN ASSOCIATES OF WISCONSIN, SC

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

## Provider details

- **NPI number:** 1437472172
- **Authorized official:** DR. JEFFREY GERARD NICHOLSON PHD, PA-C (CLINIC MANAGER)
- **Authorized official phone:** (414) 727-5467

## Contact information

- **Practice address:** 7033 WELLAUER DR, MILWAUKEE, WI 53213-3734
- **Practice address phone:** (414) 727-5467
- **Practice address fax:** (206) 222-2918
- **Mailing address:** 7033 WELLAUER DR, MILWAUKEE, WI 53213-3734
- **Mailing address phone:** (414) 727-5467
- **Mailing address fax:** (206) 222-2918

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 11224-20 | WI | — |
| 261Q00000X | Clinic/Center | 904-023 | WI | Yes |

## Other

- **Enumeration date:** 03/09/2010
- **Last updated:** 03/09/2010