# PROHEALTH MEDICAL GROUP INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PROHEALTH MEDICAL GROUP INC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1629119417
- **Legal business name:** PROHEALTH MEDICAL GROUP INC
- **Authorized official:** PETER GEISS, MD (PRESIDENT)
- **Authorized official phone:** (262) 928-8669

## Contact information

- **Practice address:** 109 AIR PARK DR, WATERTOWN, WI 53094-7400
- **Practice address phone:** (262) 928-5100
- **Practice address fax:** (262) 928-5111
- **Mailing address:** N17W24100 RIVERWOOD DR, SUITE 250, WAUKESHA, WI 53188-1177
- **Mailing address phone:** (262) 928-4100
- **Mailing address fax:** (262) 928-5835

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207K00000X | Allergy & Immunology Physician | — | NULL | — |
| 207K00000X | Allergy & Immunology Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 207Y00000X | Otolaryngology Physician | — | NULL | — |
| 207Y00000X | Otolaryngology Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | — |

## Other

- **Enumeration date:** 02/12/2007
- **Last updated:** 05/23/2022