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NPI Code Detail

MEDICARE: FAMILY TIES PRENATAL CARE LLC

MEDICARE: FAMILY TIES PRENATAL CARE LLC
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
1261QB0400XBirthing Clinic/Center

General Provider Information

NPI Number : 1922711340
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAMILY TIES PRENATAL CARE LLC
Provider Business Mailing Address
First Line : 5215 N IRONWOOD RD STE 202
Second Line :
City : GLENDALE
State : WI
Zip : 53217-4908
Country : US
Telephone Number : 414-338-6119
Fax Number :
Provider Business Practice Location Address
First Line : 5215 N IRONWOOD RD STE 202
Second Line :
City : GLENDALE
State : WI
Zip : 53217-4908
Country : US
Telephone Number : 414-338-6119
Fax Number :
Authorized Official
Title or Position : CEO
Name : TAMIKO WILDER
Credential :
Telephone Number : 414-732-5160
Provider Enumeration Date : 12/30/2022
Last Update Date : 12/30/2022

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Directions to “FAMILY TIES PRENATAL CARE LLC ” Practice Location

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