Organization
SOUTHEASTERN FAMILY PRACTICE SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NOEMI A PRIETO MD (PRESIDENT)
(414) 463-6640
Entity
Organization
Contact information
Practice address
1308 S 16TH ST, MILWAUKEE, WI 53204-2711
(414) 831-0100
(414) 831-1584
Mailing address
8532 W CAPITOL DR, MILWAUKEE, WI 53222-1848
(414) 463-6640
(414) 463-6743
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
48505
WI
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
26529
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30718400
—
WI
Enumeration date
12/20/2007
Last updated
12/20/2007
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