Provider Demographics
NPI:1215167523
Name:MARVIN
Entity type:Organization
Organization Name:MARVIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SATTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-272-4629
Mailing Address - Street 1:1218 W KILBOURN AVE
Mailing Address - Street 2:SUITE-401
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-1330
Mailing Address - Country:US
Mailing Address - Phone:414-272-4629
Mailing Address - Fax:414-272-4630
Practice Address - Street 1:1218 W KILBOURN AVE
Practice Address - Street 2:SUITE-401
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1330
Practice Address - Country:US
Practice Address - Phone:414-272-4629
Practice Address - Fax:414-272-4630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30880400Medicaid
WI391142042004OtherBLUE CROSS/ BLUE SHIELD UNITED OF WISCONSIN
WI30880400Medicaid