Organization
MAYFAIR DIGESTIVE HEALTH CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY JO BURNS (DIRECTOR REVENUE CYCLE MANAGEMENT)
(262) 970-7825
Entity
Organization
Contact information
Practice address
1033 N MAYFAIR RD, SUITE 104, WAUWATOSA, WI 53226-3442
(414) 454-0600
(414) 454-0971
Mailing address
2801 W KINNICKINNIC RIVER PKWY STE 1080, MILWAUKEE, WI 53215-3689
(414) 908-6506
(414) 908-6510
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41913000
—
WI
01
—
490005762
RAILROAD MEDICARE
WI
Enumeration date
03/02/2006
Last updated
01/08/2025
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