Healthcare Provider Details

I. General information

NPI: 1811668650
Provider Name (Legal Business Name): HOLISTIC HEALTH CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8777 W FOREST HOME AVE
GREENFIELD WI
53228-3421
US

IV. Provider business mailing address

8777 W FOREST HOME AVE
GREENFIELD WI
53228-3421
US

V. Phone/Fax

Practice location:
  • Phone: 414-231-3130
  • Fax:
Mailing address:
  • Phone: 414-231-3130
  • Fax: 414-239-8544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SAHR A LEBBIE
Title or Position: PRESIDENT
Credential:
Phone: 414-231-3130