Organization Name:  PROHEALTH MEDICAL GROUP INC


Practice Location:
N16W24131 RIVERWOOD DR  WAUKESHA, WI 53188 US
Tel: 262-696-0808  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
N	104100000X	Behavioral Health & Social Service Providers Social Worker
N	207K00000X	Physicians Allergy & Immunology
N	207N00000X	Physicians Dermatology
N	207Q00000X	Physicians Family Medicine
N	207V00000X	Physicians Obstetrics & Gynecology
N	207X00000X	Physicians Orthopaedic Surgery
N	207Y00000X	Physicians Otolaryngology
N	208000000X	Physicians Pediatrics
N	2084N0400X	Physicians Psychiatry & Neurology
N	208600000X	Physicians Surgery
N	208800000X	Physicians Urology
N	225100000X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers Physical Therapist
Y	207R00000X	Physicians Internal Medicine

Other Provider Identifiers:

Issuer	Number	State	Type
DME	0505180015	WI	01

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin