MEDICARE: CITY OF WEST ALLIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency		WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	000082012	OTHER	WI	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104025444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF WEST ALLIS

Provider Business Mailing Address
First Line	:	7120 W NATIONAL AVE
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53214-4732
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7120 W NATIONAL AVE
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53214-4732
Country	:	US
Telephone Number	:	414-302-8600
Fax Number	:

Authorized Official
Title or Position	:	HEALTH COMMISSIONER
Name	:	MR. ROBERT LEISCHOW
Credential	:
Telephone Number	:	414-302-8627

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	09/26/2022

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Directions to “CITY OF WEST ALLIS ” Practice Location

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