Provider Demographics
NPI:1104065226
Name:METRO MILWAUKEE MEDICAL INC
Entity type:Organization
Organization Name:METRO MILWAUKEE MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHISICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:AMI
Authorized Official - Middle Name:
Authorized Official - Last Name:PRAG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-957-7251
Mailing Address - Street 1:17345 CIVIC DR
Mailing Address - Street 2:P O BOX NO 1570
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-5305
Mailing Address - Country:US
Mailing Address - Phone:262-957-7251
Mailing Address - Fax:
Practice Address - Street 1:8901 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2409
Practice Address - Country:US
Practice Address - Phone:262-957-7251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46478207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty