Organization
WISCONSIN PHLEBOLOGY MEDICAL GROUP SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHAN AMORUSO (SR VP REVENUE)
(847) 593-8460
Entity
Organization
Contact information
Practice address
10614 N PORT WASHINGTON RD, MEQUON, WI 53092-5013
(262) 834-0123
Mailing address
PO BOX 1602, NORTHBROOK, IL 60065-1602
(847) 593-8460
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
—
WI
2085R0204X
Vascular & Interventional Radiology Physician
—
WI
208600000X
Surgery Physician
Primary
—
WI
2086S0129X
Vascular Surgery Physician
—
WI
Other
Enumeration date
05/24/2006
Last updated
05/04/2023
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