GREAT LAKES RADIATION ONCOLOGY, (NPI# 1861444291) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861444291 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES RADIATION ONCOLOGY, |
| Practice Address |
19333 W North Ave Brookfield WI 53045-4132 |
| Practice Telephone | 4144472221 |
| Practice Fax Number | 2626416880 |
| Mailing Telephone | 4144472221 |
| Mailing Fax Number | 2626416880 |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DAVID M SHERMAN (PRESIDENT) |
| Authorized Official Telephone | 4144472221 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RX0202X |
Internal Medicine Specialization: Medical Oncology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 21281300 | 05 |
| Street Address |
19333 W NORTH AVE |
| City | BROOKFIELD |
| State | WI |
| Zip Code | 53045-4132 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255314076 | John K Hur | Anesthesiology | 19333 W North Ave, Brookfield, WI 53045-4132 | 2005-11-25 |
| 1467063008 | Shelly Schneider Parker | Registered Nurse | 19333 W North Ave, Brookfield, WI 53045-4132 | 2020-08-16 |
| 1083224661 | Deborah Moraza | Registered Nurse | 19333 W North Ave, Brookfield, WI 53045-4132 | 2020-08-07 |
| 1659905727 | Bobbie-jo Marie King | Pharmacist | 19333 W North Ave, Brookfield, WI 53045-4198 | 2020-02-27 |
| 1477199271 | Jayne Eslinger | Physician Assistant | 19333 W North Ave, Brookfield, WI 53045-4132 | 2019-11-27 |
| 1801350632 | Anne M Hollandsworth | Nurse Anesthetist, Certified Registered | 19333 W North Ave, Brookfield, WI 53045-4132 | 2019-01-25 |
| 1245704477 | Dana J Wilson | Nurse Anesthetist, Certified Registered | 19333 W North Ave, Brookfield, WI 53045-4132 | 2019-01-22 |
| 1043788870 | Thomas M Nigro Jr. | Nurse Anesthetist, Certified Registered | 19333 W North Ave, Brookfield, WI 53045-4132 | 2018-11-09 |
| 1356819619 | Freda Lynn Erdman | Clinical Nurse Specialist | 19333 W North Ave, Brookfield, WI 53045 | 2018-11-05 |
| 1891285474 | Uche Dike | Pharmacist | 19333 W North Ave, Brookfield, WI 53045-4132 | 2018-05-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801436159 | Jeannie Spoon | Behavioral Analyst | 200 N. Patrick Blvd. Ste 250, Brookfield, WI 53045 | 2020-01-14 |
| 1629635313 | Hallie Mackenzie Ritchay | Speech-Language Pathologist | Greenfield Rehabilitation Agency 19395 W Capitol Dr, Ste 200, Brookfield, WI 53045 | 2019-05-29 |
| 1427535038 | Kimberly Ann Beres | Registered Nurse | 2253 Norhardt Dr, Brookfield, WI 53045 | 2018-07-26 |
| 1265927768 | Brady Frederick Bachmann | Physical Therapist | 275 Regency Ct., Suite 200, Brookfield, WI 53045 | 2018-06-27 |
| 1841792603 | Wisconsin Renal Care Group, L.L.C. | Clinic/Center | 17500 W Capitol Drive, Brookfield, WI 53045 | 2018-03-07 |
| 1750828299 | Nanette Marie Kloth | Nurse Practitioner | 18110 W Bluemond Rd, Brookfield, WI 53045 | 2017-01-23 |
| 1144772013 | Saida Reifenrath | Acupuncturist | 240 Regency Court, Suite 102, Brookfield, WI 53045 | 2016-10-26 |
| 1437545951 | Kylee Stevenson | Chiropractor | 19555 W Bluemound Rd Ste 6, Brookfield, WI 53045 | 2015-04-10 |
| 1548659725 | Patricia Ann Kender | Nurse Practitioner | 17495 W. Capitol Dr., Brookfield, WI 53045 | 2015-01-12 |
| 1568882793 | Kassandra E Holzem | Dermatology | 195 Discovery Dr, Brookfield, WI 53045 | 2014-04-28 |
| Find all providers in zip 53045 | ||||
| Taxonomy Code | 207RX0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Medical Oncology |
| An internist who specializes in the diagnosis and treatment of all types of cancer and other benign and malignant tumors. This specialist decides on and administers therapy for these malignancies as well as consults with surgeons and radiotherapists on other treatments for cancer. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source. 11/5/2007: corrected definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861750788 | Greg William Mccormack | Internal Medicine | 20911 Sunset Lndg, Frederic, WI 54837-9055 | 2012-04-28 |
| 1053447672 | James D Mcgovern | Internal Medicine | 3669 Point Ln, Green Bay, WI 54311-9766 | 2007-02-26 |
| 1467413591 | Francis J Cuevas | Internal Medicine | 7410 W Rawson Avenue, Franklin, WI 53132-8274 | 2006-03-29 |
| 1578530705 | Michael E Eastman | Internal Medicine | 250 Doctors Ct, Johnson Creek, WI 53038-9451 | 2006-03-07 |
| 1972570224 | Paul J. Lemarbre | Internal Medicine | W359n7430 Brown St, Oconomowoc, WI 53066-1120 | 2006-03-07 |
| 1164403226 | Michael W Jones | Internal Medicine | 480 E Division St, Fond Du Lac, WI 54935-3734 | 2005-11-07 |
| 1649278870 | Shahid Shekhani | Internal Medicine | 1000 Mineral Point Ave, Janesville, WI 53548-2940 | 2005-07-12 |
| 1982081436 | Ashanda Esdaille | Internal Medicine | 600 Highland Ave, Madison, WI 53792-2012 | 2015-05-05 |
| 1609276500 | Agnes Smaradottir | Internal Medicine | 1836 South Ave, La Crosse, WI 54601-5429 | 2014-08-27 |
| 1477819902 | Sheboygan Physicians Group, Sc | Internal Medicine | 2920 Superior Ave, Sheboygan, WI 53081-1944 | 2012-04-10 |
| Find all providers with the same taxonomy | ||||
| City | BROOKFIELD |
| Zip Code | 53045 |
Please comment or provide details below to improve the information on GREAT LAKES RADIATION ONCOLOGY,.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.