# GASTROENTEROLOGY MEDICINE S.C.

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

## Provider details

- **NPI number:** 1770544843
- **Authorized official:** MS. LIDIA DIBA MBA (MANAGER)
- **Authorized official phone:** (414) 671-0121

## Contact information

- **Practice address:** 3201 S 16TH ST, 2015, MILWAUKEE, WI 53215-4537
- **Practice address phone:** (414) 671-0121
- **Practice address fax:** (414) 671-6949
- **Mailing address:** 3201 S 16TH ST, 2015, MILWAUKEE, WI 53215-4537
- **Mailing address phone:** (414) 671-0121
- **Mailing address fax:** (414) 671-6949

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RG0100X | Gastroenterology Physician | — | NULL | Yes |
| 207RG0100X | Gastroenterology Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/29/2006
- **Last updated:** 08/22/2020