Organization
INTEGRATED BREAST SPECIALISTS, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY MIKKELSON MD (PRESIDENT)
(414) 385-8790
Entity
Organization
Contact information
Practice address
2801 W KINNICKINNIC RIVER PKWY, SUITE 165, MILWAUKEE, WI 53215-3669
(414) 385-8790
(414) 385-8791
Mailing address
2801 W KINNICKINNIC RIVER PKWY, SUITE 165, MILWAUKEE, WI 53215-3669
(414) 385-8790
(414) 385-8791
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21269900
—
WI
Enumeration date
05/24/2006
Last updated
08/22/2020
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