Organization
PREMIER CARDIOVASCULAR INSTITUTE OF WISCONSIN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OBRAD KOKANOVIC M.D. (OWNER)
(406) 750-8202
Entity
Organization
Contact information
Practice address
1309 S 54TH ST, MILWAUKEE, WI 53214-3404
(406) 750-8202
Mailing address
2500 W LAYTON AVE, SUITE 200, MILWAUKEE, WI 53221-5420
(406) 750-8202
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
51767
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127766
—
WI
Enumeration date
11/17/2014
Last updated
01/27/2015
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