Organization Name: | MAYFAIR DIGESTIVE HEALTH CENTER, LLC |
NPI Number: | 1013984657 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | NICOLE MARQUEZ (BILLING MANAGER) |
Mailing Address: | 1033 N Mayfair Rd Suite 104 Wauwatosa |
State: | WI US |
Postal Code: | 532263442 |
Phone Number: | 4144540600 |
Fax Number: | 4143852980 |
NPI Enumeration Date: | 03/02/2006 |
NPI Last Update Date: | 04/20/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QA1903X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Ambulatory Surgical |
Taxonomy Definition: |