| Commonwealth Medical Group | |
|
2500 W Layton Ave Suite 290 Milwaukee WI 53221-5420 | |
| (414) 281-9651 | |
| Not Available |
| Full Name | Commonwealth Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 2500 W Layton Ave, Milwaukee, Wisconsin |
| Authorized Official Name and Position | John Mutschelknaus (CEO) |
| Authorized Official Contact | 4147775100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Commonwealth Medical Group 2500 W Layton Ave Suite 290 Milwaukee WI 53221-5420 Ph: (414) 281-9651 | Commonwealth Medical Group 2500 W Layton Ave Suite 290 Milwaukee WI 53221-5420 Ph: (414) 281-9651 |
| NPI Number | 1912109893 |
|---|---|
| Provider Enumeration Date | 06/04/2007 |
| Last Update Date | 09/19/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912109893 | NPI | - | NPPES |
| 30862500 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 14134 (Wisconsin) | Primary |
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