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Organization
COMMONWEALTH MEDICAL GROUP, LLC
Active
Organization
COMMONWEALTH MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN A. MUTSCHELKNAUS (EXECUTIVE DIRECTOR)
(414) 777-5100
Entity
Organization
Contact information
Practice address
851 S 70TH ST, SUITE 101, WEST ALLIS, WI 53214-3147
(414) 777-5100
(414) 777-5112
Mailing address
851 S 70TH ST, SUITE 101, WEST ALLIS, WI 53214-3147
(414) 777-5100
(414) 777-5112
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
1314-029
WI
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
NULL
207RC0000X
Cardiovascular Disease Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
NULL
207RP1001X
Pulmonary Disease Physician
—
—
207UN0901X
Nuclear Cardiology Physician
—
NULL
207UN0901X
Nuclear Cardiology Physician
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
NULL
2085R0202X
Diagnostic Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
NULL
2085U0001X
Diagnostic Ultrasound Physician
—
—
225100000X
Physical Therapist
—
NULL
225100000X
Physical Therapist
—
—
2251H1200X
Hand Physical Therapist
—
NULL
2251H1200X
Hand Physical Therapist
—
—
225X00000X
Occupational Therapist
—
NULL
225X00000X
Occupational Therapist
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
Other
Enumeration date
05/27/2006
Last updated
10/09/2007
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