Provider Demographics
NPI:1154589463
Name:WHEATON FRANCISCAN HEALTHCARE
Entity type:Organization
Organization Name:WHEATON FRANCISCAN HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:PASSINAULT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:414-647-7678
Mailing Address - Street 1:3711 S 104TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-1303
Mailing Address - Country:US
Mailing Address - Phone:414-541-0712
Mailing Address - Fax:
Practice Address - Street 1:2025 W OKLAHOMA AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4455
Practice Address - Country:US
Practice Address - Phone:414-647-7678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3136261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center