Organization
MILWAUKEE GENERAL & VASCULAR SURGERY SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY ALAN EKBOM MD (VICE PRESIDENT PARTNER)
(414) 778-6670
Entity
Organization
Contact information
Practice address
10400 W NORTH AVE, #480, MILWAUKEE, WI 53226-2425
(414) 778-6670
(414) 778-6672
Mailing address
10400 W NORTH AVE, #480, MILWAUKEE, WI 53226-2425
(414) 778-6670
(414) 778-6672
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21261700
—
WI
01
—
C01747
MEDICARE RAILROAD PIN
WI
Enumeration date
04/04/2007
Last updated
06/24/2010
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