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NPI Code Detail

MEDICARE: ANSA TREATMENT CENTER INC

MEDICARE: ANSA TREATMENT CENTER INC
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
1261QM2800XMethadone Clinic

General Provider Information

NPI Number : 1740767292
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANSA TREATMENT CENTER INC
Provider Business Mailing Address
First Line : 4111 N PORT WASHINGTON RD STE 101A
Second Line :
City : MILWAUKEE
State : WI
Zip : 53212-1029
Country : US
Telephone Number : 414-431-8782
Fax Number :
Provider Business Practice Location Address
First Line : 4111 N PORT WASHINGTON RD STE 101A
Second Line :
City : MILWAUKEE
State : WI
Zip : 53212-1029
Country : US
Telephone Number : 414-431-8782
Fax Number :
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : SYED Q HUSSAINI
Credential : MD
Telephone Number : 414-431-8782
Provider Enumeration Date : 07/26/2018
Last Update Date : 07/26/2018

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Directions to “ANSA TREATMENT CENTER INC ” Practice Location

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