| Family Practice Clinic Of Mayfair Sc | |
|
11803 W North Ave Wauwatosa WI 53226 | |
| (414) 258-5522 | |
| (414) 258-1337 |
| Full Name | Family Practice Clinic Of Mayfair Sc |
|---|---|
| Speciality | General Practice |
| Location | 11803 W North Ave, Wauwatosa, Wisconsin |
| Authorized Official Name and Position | Marlene B Knie (OFFICE MANAGER) |
| Authorized Official Contact | 4142585522 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Practice Clinic Of Mayfair Sc 11803 W North Ave Wauwatosa WI 53226 Ph: (414) 258-5522 | Family Practice Clinic Of Mayfair Sc 11803 W North Ave Wauwatosa WI 53226 Ph: (414) 258-5522 |
| NPI Number | 1295810208 |
|---|---|
| Provider Enumeration Date | 10/26/2006 |
| Last Update Date | 10/29/2007 |
| Medicare PECOS PAC ID | 8325089311 |
|---|---|
| Medicare Enrollment ID | O20050519000867 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295810208 | NPI | - | NPPES |
| 30074100 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Patrick Krzyzewski |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1053496067 PECOS PAC ID: 0345356234 Enrollment ID: I20101229001056 |
| Provider Name | Jose G Araujo |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1033282967 PECOS PAC ID: 8628032182 Enrollment ID: I20140728001663 |
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