Organization
WISCONSIN HEART GROUP ASSOCIATES LLC
Active
Parent organization
WISCONSIN HEART GROUP, S.C.
Organization subpart
Yes
Provider details
NPI number
Legal business name
WISCONSIN HEART GROUP, S.C.
Authorized official
MRS. KIMBERLY ANN COUCH (EXECUTIVE ADMINISTRATIVE ASSISTANT)
(262) 754-3613
Entity
Organization
Contact information
Practice address
16650 W BLUEMOUND RD, SUITE 200, BROOKFIELD, WI 53005-5920
(262) 827-9200
(262) 827-9858
Mailing address
16650 W BLUEMOUND RD, SUITE 200, BROOKFIELD, WI 53005-5920
(262) 827-9200
(262) 827-9858
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
—
WI
207RI0011X
Interventional Cardiology Physician
—
WI
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32678600
—
WI
Enumeration date
09/14/2009
Last updated
09/15/2015
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