Organization
INTERPEDIA, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID BRUCE TICK M.D. (PRESIDENT)
(262) 241-5414
Entity
Organization
Contact information
Practice address
216 GREEN BAY RD STE 109, THIENSVILLE, WI 53092-1625
(262) 241-5414
(262) 672-4046
Mailing address
216 GREEN BAY RD STE 109, THIENSVILLE, WI 53092-1625
(262) 241-5414
(262) 672-4046
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
34022
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31891200
—
WI
Enumeration date
01/26/2006
Last updated
05/11/2018
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