Organization
FAMILY PRACTICE CLINIC OF MAYFAIR SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARLENE B KNIE (OFFICE MANAGER)
(414) 258-5522
Entity
Organization
Contact information
Practice address
11803 W NORTH AVE, WAUWATOSA, WI 53226
(414) 258-5522
(414) 258-1337
Mailing address
11803 W NORTH AVE, WAUWATOSA, WI 53226
(414) 258-5522
(414) 258-1337
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30074100
—
WI
Enumeration date
10/26/2006
Last updated
10/29/2007
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