Provider Demographics
NPI:1487991824
Name:WISCONSIN PAIN MANAGEMENT, S.C.
Entity type:Organization
Organization Name:WISCONSIN PAIN MANAGEMENT, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:G
Authorized Official - Last Name:CONRARDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-763-8000
Mailing Address - Street 1:225 S EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4257
Mailing Address - Country:US
Mailing Address - Phone:262-787-4050
Mailing Address - Fax:262-782-6040
Practice Address - Street 1:1050 MILWAUKEE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1362
Practice Address - Country:US
Practice Address - Phone:262-763-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical