MEDICARE: COMPREHENSIVE MEDICAL RELIEF CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	225100000X	Physical Therapist
3	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1487001103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE MEDICAL RELIEF CENTER

Provider Business Mailing Address
First Line	:	PO BOX 26008
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-0008
Country	:	US
Telephone Number	:	414-434-4248
Fax Number	:	414-431-8608

Provider Business Practice Location Address
First Line	:	4111 N PORT WASHINGTON RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-1029
Country	:	US
Telephone Number	:	414-434-4248
Fax Number	:	414-431-8608

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. MOHAMMAD ALI
Credential	:
Telephone Number	:	414-434-4248

Provider Enumeration Date	:	05/23/2016
Last Update Date	:	09/12/2016

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