# HERITAGE CLINIC S.C.

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

## Provider details

- **NPI number:** 1588736276
- **Authorized official:** DR. RAYMOND PAUL MAGER D.O. (PRESIDENT)
- **Authorized official phone:** (414) 771-6020

## Contact information

- **Practice address:** 201 N MAYFAIR RD, SUITE 535, WAUWATOSA, WI 53226-4216
- **Practice address phone:** (414) 771-6020
- **Practice address fax:** (414) 771-2242
- **Mailing address:** 9449 N BROADMOOR RD, BAYSIDE, WI 53217-1310
- **Mailing address phone:** (414) 771-6020
- **Mailing address fax:** (414) 771-2242

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 19290 | WI | Yes |

## Other

- **Enumeration date:** 11/15/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 30032400 | — | WI |