Healthcare Provider Details

I. General information

NPI: 1861859902
Provider Name (Legal Business Name): WISCONSIN HEALTHCARE NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2016
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 W BROWN DEER RD STE 228
MILWAUKEE WI
53223-2311
US

IV. Provider business mailing address

5600 W BROWN DEER RD STE 228
MILWAUKEE WI
53223-2311
US

V. Phone/Fax

Practice location:
  • Phone: 414-841-0104
  • Fax:
Mailing address:
  • Phone: 414-841-0104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAKEESHA ROBINSON
Title or Position: OWNER
Credential:
Phone: 414-841-0104