Premier Cardiovascular Institute of Wisconsin LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

51767 Issued in WI

Legal business name

PREMIER CARDIOVASCULAR INSTITUTE OF WISCONSIN LLC

Practice address

1309 S 54TH St
Milwaukee, WI 53214-3404

Phone

(406) 750-8202

NPI assigned

Nov 17, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Obrad Kokanovic, M.D.

Title

Owner

Phone

(406) 750-8202

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1416182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422316800000",
    "number": "1104222330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 W LAYTON AVE",
            "address_2": "SUITE 200",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532215420",
            "telephone_number": "406-750-8202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1309 S 54TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532143404",
            "telephone_number": "406-750-8202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER CARDIOVASCULAR INSTITUTE OF WISCONSIN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-17",
        "last_updated": "2015-01-27",
        "status": "A",
        "authorized_official_last_name": "KOKANOVIC",
        "authorized_official_first_name": "OBRAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "406-750-8202",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "WI",
            "license": "51767",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127766",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.