Organization
MEDVED ENT, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER M MEDVED M.D. (PRESIDENT)
(414) 529-9330
Entity
Organization
Contact information
Practice address
9200 W LOOMIS RD, SUITE 206, FRANKLIN, WI 53132-8887
(414) 529-9330
(414) 529-9331
Mailing address
9200 W LOOMIS RD, SUITE 206, FRANKLIN, WI 53132-8887
(414) 529-9330
(414) 529-9331
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
24579
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30756000
—
WI
Enumeration date
05/08/2007
Last updated
04/07/2011
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