Organization
COGENT HEALTHCARE OF WISCONSIN, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA FALL (MANAGER)
(253) 682-6040
Entity
Organization
Contact information
Practice address
2900 W OKLAHOMA AVE, SUITE D2121, MILWAUKEE, WI 53215-4330
(414) 385-2590
Mailing address
120 BRENTWOOD COMMONS WAY STE 510, BRENTWOOD, TN 37027-2028
(253) 682-6040
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
208M00000X
Hospitalist Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21279200
—
WI
01
—
2700034207
BCBS WI
WI
Enumeration date
06/11/2006
Last updated
05/07/2025
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