Basic Information
| Provider Information | |||||||||
| NPI: | 1942970405 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHILDREN'S SPECIALTY GROUP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 1997 | ||||||||
| Address2: | MS 900 - ROSALIE O'MEARA | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532011997 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142666223 | ||||||||
| FaxNumber: | 4142666338 | ||||||||
| Practice Location | |||||||||
| Address1: | 9000 W WISCONSIN AVE | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532264874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142662000 | ||||||||
| FaxNumber: | 4142666338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2021 | ||||||||
| LastUpdateDate: | 09/16/2021 | ||||||||
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| AuthorizedOfficialLastName: | CADIEUX | ||||||||
| AuthorizedOfficialFirstName: | MARC | ||||||||
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| AuthorizedOfficialTitleorPosition: | CORPORATE VP & CFO | ||||||||
| AuthorizedOfficialTelephone: | 4142666226 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 09/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.