Provider Demographics
NPI:1902991805
Name:GREATER MILWAUKEE OTOLARYNGOLOGY LLC
Entity Type:Organization
Organization Name:GREATER MILWAUKEE OTOLARYNGOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:DANKLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-281-4466
Mailing Address - Street 1:4600 W LOOMIS RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4858
Mailing Address - Country:US
Mailing Address - Phone:414-281-4466
Mailing Address - Fax:414-281-4528
Practice Address - Street 1:4600 W LOOMIS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4858
Practice Address - Country:US
Practice Address - Phone:414-281-4466
Practice Address - Fax:414-281-4528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21289200Medicaid
WI21289200Medicaid