Provider Demographics
NPI:1588255996
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 PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:877-287-1962
Mailing Address - Street 1:5434 W CAPITOL DR STE 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:866-225-2790
Practice Address - Street 1:6125 GREEN BAY RD STE 600
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-2928
Practice Address - Country:US
Practice Address - Phone:877-287-1962
Practice Address - Fax:855-809-8128
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDEPENDENT PHYSICIANS OF WISCONSIN, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies