Provider Demographics
NPI:1770524191
Name:WEST SUBURBAN CARDIOTHORACIC SURGERY SC
Entity type:Organization
Organization Name:WEST SUBURBAN CARDIOTHORACIC SURGERY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:SEIFERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-522-6900
Mailing Address - Street 1:N14W23833 STONE RIDGE DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1157
Mailing Address - Country:US
Mailing Address - Phone:262-522-6900
Mailing Address - Fax:262-522-6835
Practice Address - Street 1:N14W23833 STONE RIDGE DR
Practice Address - Street 2:SUITE 240
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1157
Practice Address - Country:US
Practice Address - Phone:262-522-6900
Practice Address - Fax:262-522-6835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21256600Medicaid
WI21256600Medicaid
WI01130Medicare ID - Type Unspecified