SOUTHEASTERN PEDIATRICS, SC (NPI# 1154765410) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154765410 |
| Entity Type | Organization |
| Organization Name | SOUTHEASTERN PEDIATRICS, SC |
| Practice Address |
10625 W North Ave Ste 326 Wauwatosa WI 53226-2315 |
| Mailing Address |
7592 Solutions Ctr # 777592 Chicago IL 60677-7005 |
| Practice Telephone | 4147710500 |
| Practice Fax Number | 4147710363 |
| Mailing Telephone | 2626413700 |
| Mailing Fax Number | 2626413719 |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2017-11-03 |
| Authorized Official Name | RATIDZAI RIOGA (PRESIDENT) |
| Authorized Official Telephone | 4147710500 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| N | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
41265 | WI | Allopathic & Osteopathic Physicians |
| Y | 207Q00000X | Family Medicine | 41265 | WI | Allopathic & Osteopathic Physicians |
| Street Address |
10625 W NORTH AVE STE 326 |
| City | WAUWATOSA |
| State | WI |
| Zip Code | 53226-2315 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437215001 | Ratidzai Rioga | Family Medicine | 10625 W North Ave Ste 326, Wauwatosa, WI 53226-2315 | 2006-12-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912511155 | Alexander Harlan | Pharmacist | 900 N 92nd St, Milwaukee, WI 53226 | 2020-09-04 |
| 1558985762 | Armghan Haider Ans | Student in an Organized Health Care Education/Training Program | 9200 W. Wisconsin Ave. Froedtert Hospital & Medical Col, Milwaukee, WI 53226 | 2020-06-03 |
| 1669001103 | Kimberly Tyler | Student in an Organized Health Care Education/Training Program | 8701 W Watertown Plank Road, Medical College of Wisconsin Dept of Internal Medicine, Wauwatosa, WI 53226 | 2020-04-06 |
| 1972131993 | Francesca Meloy Devine | Student in an Organized Health Care Education/Training Program | Medical Education Office: Children's Corporate Center, 999 N. 92nd St., Suite 730, Milwaukee, WI 53226 | 2020-03-27 |
| 1285275248 | Sharitta Alford | Technician | 12250 West North Avenue, Apartment 142b, Wauwatosa, WI 53226 | 2019-10-01 |
| 1619528023 | Linda Marie Sabatinelli | Technician | 12107 W. Woodland Ave, Wauwatosa, WI 53226 | 2019-09-26 |
| 1598310195 | Matthew Laviolette | Surgery | Medical College of Wisconsin, 8701 Watertown Plank Rd., Surgical Oncology, Milwaukee, WI 53226 | 2019-08-09 |
| 1962056432 | Lyndsey Marie Bratberg | Physician Assistant | F&mcw Clinical Cancer Center 9200 W. Wisconsin Ave., Milwaukee, WI 53226 | 2019-08-01 |
| 1659832855 | Benjamin David Seadler | Surgery | Mcw, Department of Surgery, 8701 Watertown Plank Road, Milwaukee, WI 53226 | 2019-03-29 |
| 1861953267 | Michael Dryden | Student in an Organized Health Care Education/Training Program | 8701 Watertown Plank Rd., Milwaukee, WI 53226 | 2019-03-27 |
| Find all providers in zip 53226 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750547758 | Ravi Gupta,m.d.,s.c. | Family Medicine | 10625 W North Ave Ste 230, Wauwatosa, WI 53226-2315 | 2008-07-30 |
| 1013182815 | Cheryl Gupta | Family Medicine | 3820 W Bluemound Rd, Suite 125, Wauwatosa, WI 53213 | 2008-04-23 |
| 1083806814 | Danielle G. Tonelli | Family Medicine | 8320 W. Bluemound Rd, Suite 125, Wauwatosa, WI 53213-3367 | 2007-08-15 |
| 1437215001 | Ratidzai Rioga | Family Medicine | 10625 W North Ave Ste 326, Wauwatosa, WI 53226-2315 | 2006-12-28 |
| 1154367811 | Harold Pennington Ducloux | Family Medicine | 10400 W North Avve Suite 490, Amg Mid-market Urgent Care Group, Wauwatosa, WI 53226-5701 | 2006-06-21 |
| 1386611143 | George H Rabey | Family Medicine | 3300 N 124th St, Wauwatosa, WI 53222-3106 | 2006-03-01 |
| 1356797609 | Khyati Soni | Family Medicine | 1055 N Mayfair Rd, Wauwatosa, WI 53226-3436 | 2016-05-05 |
| 1982067922 | Joseph Vogelgesang | Family Medicine | 8320 W Bluemound Rd Ste 125, Wauwatosa, WI 53213-3367 | 2016-03-29 |
| 1124407655 | Elizabeth Benson Partain | Family Medicine | 1155 N Mayfair Rd, Wauwatosa, WI 53226-3462 | 2015-05-29 |
| 1841686466 | Jordan H. Hughes | Family Medicine | 1155 N Mayfair Rd, Wauwatosa, WI 53226-3462 | 2015-04-09 |
| Find all providers in WAUWATOSA | ||||
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| 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.