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Contact Information

COMMONWEALTH MEDICAL GROUP, LLC
851 S 70TH ST
SUITE 101
WEST ALLIS, WI53214-3147
 Phone: 414-777-5100
 Fax: 414-777-5112
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
 

Cardiovascular Disease

207RC0000X 11 Physician/Internal Medicine
 

Diagnostic Radiology

2085R0202X 30 Physician/Diagnostic Radiology
 

Diagnostic Ultrasound

2085U0001X
 

Dietitian, Registered

133V00000X 71 Registered Dietitian or Nutrition Professional
 

Family Medicine

207Q00000X 08 Physician/Family Practice
 

Hand

2251H1200X 65 Physical Therapist in Private Practice
 

Nuclear Cardiology

207UN0901X 36 Physician/Nuclear Medicine
 

Occupational Therapist

225X00000X 67 Occupational Therapist in Private Practice
 

Pediatrics

208000000X 37 Physician/Pediatric Medicine
 

Physical Medicine & Rehabilitation

208100000X 25 Physician/Physical Medicine and Rehabilitation
 

Physical Therapist

225100000X 65 Physical Therapist in Private Practice
 

Physician Assistant

363A00000X 97 Physician Assistant
 

Pulmonary Disease

207RP1001X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for COMMONWEALTH MEDICAL GROUP, LLC

NPI Number 1477500361
LBN Legal business name COMMONWEALTH MEDICAL GROUP, LLC
Authorized official JOHN MUTSCHELKNAUS - (EXECUTIVE DIRECTOR)
Entity Organization
Organization subpart 1 No
Enumeration date 05/27/2006
Last updated 10/09/2007 - About 19 years ago
Identifiers
WI License # 1314-029
WI Medicaid 21251000
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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