Organization
IMPACT PHYSICIAN GROUP, WISCONSIN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL MILLER (CEO)
(678) 967-5599
Entity
Organization
Contact information
Practice address
3200 S 103RD ST, MILWAUKEE, WI 53227-4104
(469) 640-6500
Mailing address
21 EASTBROOK BND STE 218, PEACHTREE CITY, GA 30269-1546
(678) 967-5599
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
09/03/2021
Last updated
12/19/2022
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