Organization
MERCY FAMILY PRACTICE SC
Active
Other names
Mercy Family Practice Service Corporation
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN P ROSTEING MD MSMI (BUSINESS MANAGER)
(920) 347-1990
Entity
Organization
Contact information
Practice address
1500 HERITAGE RD, SUITE A, DE PERE, WI 54115-4017
(920) 347-1990
(920) 347-1991
Mailing address
1500 HERITAGE RD, SUITE A, DE PERE, WI 54115-4017
(920) 347-1990
(920) 347-1991
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000007335
MEDICARE ID
WI
05
—
34129300
—
WI
Enumeration date
01/02/2007
Last updated
03/04/2015
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