Organization
PROHEALTH MEDICAL GROUP INC
Active
Parent organization
PROHEALTH MEDICAL GROUP INC
Other names
ProHealth Care Medical Associates
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROHEALTH MEDICAL GROUP INC
Authorized official
JIM LYONS (PRESIDENT)
(262) 928-7636
Entity
Organization
Contact information
Practice address
W165N5595 CREEKWOOD XING, MENOMONEE FALLS, WI 53051-0685
(262) 373-2600
Mailing address
N17W24100 RIVERWOOD DR, SUITE 250, WAUKESHA, WI 53188-1177
(262) 928-6225
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
—
—
208200000X
Plastic Surgery Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32652600
—
WI
Enumeration date
05/24/2011
Last updated
05/24/2022
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