Provider Demographics
NPI:1326555442
Name:INDEPENDENT PHYSICIANS OF WISCONSIN LLC
Entity type:Organization
Organization Name:INDEPENDENT PHYSICIANS OF WISCONSIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-355-8010
Mailing Address - Street 1:5434 W. CAPITOL DR SUITE 3
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2298
Mailing Address - Country:US
Mailing Address - Phone:414-875-0505
Mailing Address - Fax:414-875-6786
Practice Address - Street 1:140 E. WATER ST. STE 1
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-3415
Practice Address - Country:US
Practice Address - Phone:262-355-8010
Practice Address - Fax:262-355-8011
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDEPENDENT PHYSICIANS OF WISCONSIN, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-10
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty