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Organization

HERITAGE CLINIC S.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. RAYMOND PAUL MAGER D.O. (PRESIDENT)
(414) 771-6020
Entity
Organization

Contact information

Practice address
201 N MAYFAIR RD, SUITE 535, WAUWATOSA, WI 53226-4216
(414) 771-6020
(414) 771-2242
Mailing address
9449 N BROADMOOR RD, BAYSIDE, WI 53217-1310
(414) 771-6020
(414) 771-2242

Taxonomy

Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
19290
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
30032400
WI
Enumeration date
11/15/2006
Last updated
08/22/2020
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