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NPI Code Detail

MEDICARE: MR. MICHAEL JOSEPH CORLISS MSW LCSW

MEDICARE: MR. MICHAEL JOSEPH CORLISS MSW LCSW
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
11041C0700XClinical Social Worker7010-123WI

Other Identifiers

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

General Provider Information

NPI Number : 1780690255
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL JOSEPH CORLISS MSW LCSW
Provider Business Mailing Address
First Line : 8901 W CAPITOL DR
Second Line :
City : MILWAUKEE
State : WI
Zip : 53222-1706
Country : US
Telephone Number : 414-463-1880
Fax Number :
Provider Business Practice Location Address
First Line : 8901 W CAPITOL DR
Second Line :
City : MILWAUKEE
State : WI
Zip : 53222-1706
Country : US
Telephone Number : 414-463-1880
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2006
Last Update Date : 07/08/2007

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