Healthcare Provider Details

I. General information

NPI: 1427162130
Provider Name (Legal Business Name): H CHARLES HIGH MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2524 E WEBSTER PL SUITE 203
MILWAUKEE WI
53211-4256
US

IV. Provider business mailing address

2524 E WEBSTER PL SUITE 203
MILWAUKEE WI
53211-4256
US

V. Phone/Fax

Practice location:
  • Phone: 414-964-9200
  • Fax:
Mailing address:
  • Phone: 414-964-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number514-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: