Organization
MOBILE MEDICAL SPECIALISTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT STOLLENWERK (PRESIDENT)
(262) 691-1000
Entity
Organization
Contact information
Practice address
146 PARK AVE, PEWAUKEE, WI 53072-3410
(262) 691-1000
(262) 264-5429
Mailing address
146 PARK AVE, PEWAUKEE, WI 53072-3410
(262) 691-1000
(262) 264-5429
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
152W00000X
Optometrist
—
—
171100000X
Acupuncturist
—
—
213E00000X
Podiatrist
—
—
231H00000X
Audiologist
—
—
253Z00000X
In Home Supportive Care Agency
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100021548
—
WI
Enumeration date
01/10/2012
Last updated
07/03/2012
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