Provider Type Icon

SOUTHEASTERN PEDIATRIC & ADOLESCENT MEDICINE S.C. NPI 1457483612


NPI Information

NPI: 1457483612
Provider Name: SOUTHEASTERN PEDIATRIC & ADOLESCENT MEDICINE, S.C.

Doing Business As: SOUTHEASTERN PEDIATRIC & ADOLESCENT MEDICINE

Classification: Pediatrics - 208000000X
Entity Type: Organization
Address:
8532 W CAPITOL DR
MILWAUKEE, WI
ZIP 53222
Phone: (414) 463-2607
Get Directions

SOUTHEASTERN PEDIATRIC & ADOLESCENT MEDICINE, S.C. is a pediatrics in Milwaukee, WI. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. SOUTHEASTERN PEDIATRIC & ADOLESCENT MEDICINE, S.C. NPI is 1457483612. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Southeastern Pediatric & Adolescent Medicine.

The provider's business location address is:

8532 W CAPITOL DR
MILWAUKEE, WI
ZIP 53222-848
Phone: (414) 463-2607
Fax: (414) 463-6743

The provider's authorized official is Rosie Deltoro .
The authorized official title is Assistant Office Manager and has the following contact phone number (414) 463-2607.

The enumeration date for this NPI number is 3/12/2007 and was last updated on 4/30/2015.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatricsYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
132787700MEDICAIDWISCONSIN

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

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.