Wisconsin Medical Group

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

5440321 Issued in WI

Legal business name

WISCONSIN MEDICAL GROUP

Practice address

8800 W Lincoln Ave
West Allis, WI 53227-2400

Phone

(262) 339-9797

NPI assigned

Oct 18, 2016

Last updated

Oct 18, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Haley Kehoe, D.O.

Title

Owner

Phone

(262) 339-9797

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1476748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476748800000",
    "number": "1326599945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14295 WOODMOUNT DR",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530052390",
            "telephone_number": "262-339-9797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8800 W LINCOLN AVE",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532272400",
            "telephone_number": "262-339-9797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISCONSIN MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-18",
        "last_updated": "2016-10-18",
        "status": "A",
        "authorized_official_last_name": "KEHOE",
        "authorized_official_first_name": "HALEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-339-9797",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "5440321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Wisconsin Dental Group, S.C. (ForwardDental West Allis)
• Wisconsin Oral Surgery & Dental Implants, S.C.
• Wisconsin Oral Surgery LLC
• Wisconsin Renal Care Group, L.L.C. (WRCG Centre Point)
• Wisconsin Vision, LLC
• Ashly Marie Witkowiak, LCSW

• Family Medicine Physician in West Allis, WI
• Providers in West Allis, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2016; 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.