Organization
PREMIERE MEDICAL LLC
Active
Organization
PREMIERE MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAUREEN TSOGBE APNP (PRESIDENT/OWNER)
(301) 908-9136
Entity
Organization
Contact information
Practice address
6877 N SEVILLE AVE, MILWAUKEE, WI 53209-2645
(414) 247-9005
(414) 247-9004
Mailing address
PO BOX 639, THIENSVILLE, WI 53092-0639
(414) 247-9005
(414) 247-9004
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
4763
WI
Other
Enumeration date
12/14/2017
Last updated
12/14/2017
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