Healthcare Provider Details

I. General information

NPI: 1386774958
Provider Name (Legal Business Name): CITY OF MILWAUKEE HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 N BROADWAY FL 3
MILWAUKEE WI
53202-3639
US

IV. Provider business mailing address

841 N BROADWAY FL 3
MILWAUKEE WI
53202-3639
US

V. Phone/Fax

Practice location:
  • Phone: 414-286-3521
  • Fax:
Mailing address:
  • Phone: 414-286-3521
  • Fax: 414-286-5990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateWI

VIII. Authorized Official

Name: BEVAN K BAKER
Title or Position: COMMISSIONER OF HEALTH
Credential: FACHE
Phone: 414-286-3521