| Interpedia, S.c. | |
|
216 Green Bay Rd Ste 109 Thiensville WI 53092-1625 | |
| (262) 241-5414 | |
| (262) 672-4046 |
| Full Name | Interpedia, S.c. |
|---|---|
| Speciality | Clinic/Center |
| Location | 216 Green Bay Rd Ste 109, Thiensville, Wisconsin |
| Authorized Official Name and Position | David Bruce Tick (PRESIDENT) |
| Authorized Official Contact | 2622415414 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Interpedia, S.c. 216 Green Bay Rd Ste 109 Thiensville WI 53092-1625 Ph: (262) 241-5414 | Interpedia, S.c. 216 Green Bay Rd Ste 109 Thiensville WI 53092-1625 Ph: (262) 241-5414 |
| NPI Number | 1568432979 |
|---|---|
| Provider Enumeration Date | 01/26/2006 |
| Last Update Date | 05/11/2018 |
| Medicare PECOS PAC ID | 5698856375 |
|---|---|
| Medicare Enrollment ID | O20080118000721 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568432979 | NPI | - | NPPES |
| 31891200 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 34022 (Wisconsin) | Primary |
| Provider Name | David B Tick |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972571313 PECOS PAC ID: 7911802434 Enrollment ID: I20031205000682 |
| Provider Name | Michael G Olaciregui |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811094972 PECOS PAC ID: 0840238762 Enrollment ID: I20050503000225 |
| Provider Name | Virendra Misra |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1780648048 PECOS PAC ID: 8527001023 Enrollment ID: I20050606000955 |
| Provider Name | Dennis J Maiman |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1265483010 PECOS PAC ID: 8628980307 Enrollment ID: I20060404000344 |
| Provider Name | Pamela D Powell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134463862 PECOS PAC ID: 9133372006 Enrollment ID: I20130102000165 |
| Provider Name | Rebecca R Russ |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609328277 PECOS PAC ID: 5698054195 Enrollment ID: I20161123001496 |
Ozaukee Medical Group, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 407 N Main St, Thiensville, WI 53092 Phone: 262-242-3000 Fax: 262-242-7191 | |
North Shore Internal Medicine Specialist, Sc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 140 S Main St, Thiensville, WI 53092 Phone: 262-242-3369 Fax: 262-242-3219 | |
Thiensville Family Health Care Sc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 140 S Main St, Thiensville, WI 53092 Phone: 262-242-3369 Fax: 262-242-3219 | |
Orthotic Wi Md Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 216 Green Bay Rd, Thiensville, WI 53092 Phone: 414-764-9550 Fax: 414-435-3110 |