Healthcare Provider Details

I. General information

NPI: 1417555418
Provider Name (Legal Business Name): MOTHER AND CHILD PRENATAL CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11414 W PARK PL STE 202
MILWAUKEE WI
53224-3500
US

IV. Provider business mailing address

11414 W PARK PL STE 202
MILWAUKEE WI
53224-3500
US

V. Phone/Fax

Practice location:
  • Phone: 414-716-6100
  • Fax:
Mailing address:
  • Phone: 414-716-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ANGELA CURETON
Title or Position: CEO
Credential:
Phone: 262-595-8341