Provider Demographics
NPI:1194798025
Name:MAMEROW, STEVEN J (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:MAMEROW
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:N17 W24100 RIVERWOOD DRIVE
Mailing Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES, INC.
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1177
Mailing Address - Country:US
Mailing Address - Phone:262-928-4100
Mailing Address - Fax:262-928-5835
Practice Address - Street 1:S69 W15636 JANESVILLE ROAD
Practice Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES, INC
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-7900
Practice Address - Country:US
Practice Address - Phone:262-928-7000
Practice Address - Fax:414-422-2075
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2011-10-13
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Provider Licenses
StateLicense IDTaxonomies
WI22448207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30380700Medicaid
WIB54787Medicare UPIN
WI683750598Medicare PIN