Organization
EASTERN WISCONSIN MEDICAL COMPANY S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHAN AMORUSO (SR VP REVENUE)
(847) 593-8460
Entity
Organization
Contact information
Practice address
245 S EXECUTIVE DR STE 350, BROOKFIELD, WI 53005-4214
(262) 373-1647
(262) 373-1650
Mailing address
PO BOX 1602, NORTHBROOK, IL 60065-1602
(847) 593-8460
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
208600000X
Surgery Physician
Primary
—
—
2086S0129X
Vascular Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100074290
—
WI
Enumeration date
12/11/2017
Last updated
05/04/2023
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