Provider Demographics
NPI:1609617133
Name:FROEDTERT HEALTH
Entity type:Organization
Organization Name:FROEDTERT HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAITLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-777-3979
Mailing Address - Street 1:901 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-1425
Mailing Address - Country:US
Mailing Address - Phone:414-978-5974
Mailing Address - Fax:
Practice Address - Street 1:901 N 9TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1425
Practice Address - Country:US
Practice Address - Phone:414-978-5974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FROEDTERT &THE MEDICAL COLLEGE OF WISCONSIN COMMUNITY PHYSICIANS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site