Provider Demographics
NPI:1053591990
Name:UROLOGY INSTITUTE OF WAUKESHA SC
Entity type:Organization
Organization Name:UROLOGY INSTITUTE OF WAUKESHA SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:W PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:FLANAGAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:262-542-9707
Mailing Address - Street 1:1111 DELAFIELD ST STE 12
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3431
Mailing Address - Country:US
Mailing Address - Phone:262-542-9707
Mailing Address - Fax:262-542-9708
Practice Address - Street 1:1111 DELAFIELD ST STE 12
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3431
Practice Address - Country:US
Practice Address - Phone:262-542-9707
Practice Address - Fax:262-542-9708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29199020208800000X
2088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31395600Medicaid
WI68763Medicare PIN
WIB84843Medicare UPIN