Provider Demographics
NPI:1053388553
Name:CARDIOTHORACIC SURGERY GROUP SC
Entity type:Organization
Organization Name:CARDIOTHORACIC SURGERY GROUP SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCMANUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-271-5119
Mailing Address - Street 1:2315 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-4516
Mailing Address - Country:US
Mailing Address - Phone:414-271-5119
Mailing Address - Fax:414-271-3756
Practice Address - Street 1:2315 N LAKE DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4516
Practice Address - Country:US
Practice Address - Phone:414-271-5119
Practice Address - Fax:414-271-3756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32895200Medicaid
WI73151Medicare ID - Type Unspecified
WI32895200Medicaid