Organization Name: | COMMONWEALTH MEDICAL GROUP, LLC |
NPI Number: | 1477500361 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOHN A. MUTSCHELKNAUS (EXECUTIVE DIRECTOR) |
Mailing Address: | 851 S 70th St Suite 101 West Allis |
State: | WI US |
Postal Code: | 532143147 |
Phone Number: | 4147775100 |
Fax Number: | 4147775112 |
NPI Enumeration Date: | 05/27/2006 |
NPI Last Update Date: | 10/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133V00000X |
License Number: | 1314-029 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WI |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Dietitian, Registered |
Taxonomy Specialization: | |
Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |