SOUTHEASTERN FAMILY PRACTICE SC NPI 1134303621

NPI Information

NPI: 1134303621
Provider Name: SOUTHEASTERN FAMILY PRACTICE SC
Classification: Pediatrics - 2080A0000X
Entity Type: Organization

Specialization: Adolescent Medicine

Address:
1308 S 16TH ST
MILWAUKEE, WI
ZIP 53204
Phone: (414) 831-0100
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SOUTHEASTERN FAMILY PRACTICE SC is an adolescent medicine pediatrics in Milwaukee, WI. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. SOUTHEASTERN FAMILY PRACTICE SC NPI is 1134303621. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1308 S 16TH ST
MILWAUKEE, WI
ZIP 53204-711
Phone: (414) 831-0100
Fax: (414) 831-1584

The provider's authorized official is Noemi A Prieto .
The authorized official title is President and has the following contact phone number (414) 463-6640.

The enumeration date for this NPI number is 12/20/2007 and was last updated on 12/20/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207R00000X	Internal Medicine		48505	WISCONSIN	No
2	2080A0000X	Pediatrics	Adolescent Medicine	26529	WISCONSIN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	30718400	MEDICAID	WISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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