# INTERPEDIA, S.C.

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

## Provider details

- **NPI number:** 1568432979
- **Authorized official:** DR. DAVID BRUCE TICK M.D. (PRESIDENT)
- **Authorized official phone:** (262) 241-5414

## Contact information

- **Practice address:** 216 GREEN BAY RD STE 109, THIENSVILLE, WI 53092-1625
- **Practice address phone:** (262) 241-5414
- **Practice address fax:** (262) 672-4046
- **Mailing address:** 216 GREEN BAY RD STE 109, THIENSVILLE, WI 53092-1625
- **Mailing address phone:** (262) 241-5414
- **Mailing address fax:** (262) 672-4046

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 34022 | WI | Yes |

## Other

- **Enumeration date:** 01/26/2006
- **Last updated:** 05/11/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 31891200 | — | WI |