Organization
MILWAUKEE EAR NOSE THROAT CLINIC LIMITED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT JOSEPH GOGAN (CEO)
(262) 241-8000
Entity
Organization
Contact information
Practice address
10945 N PORT WASHINGTON RD STE 211, MEQUON, WI 53092-5078
(262) 241-8000
(262) 241-8096
Mailing address
10945 N PORT WASHINGTON RD, SUITE 211, MEQUON, WI 53092-5078
(262) 241-8000
(262) 241-8096
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
—
—
207YS0123X
Facial Plastic Surgery Physician
Primary
—
—
231H00000X
Audiologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30326800
—
WI
01
—
C01734
RRB
WI
Enumeration date
01/30/2007
Last updated
01/07/2020
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