Healthcare Provider Details

I. General information

NPI: 1518005818
Provider Name (Legal Business Name): MILWAUKEE HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 N DR MARTIN LUTHER KING DR
MILWAUKEE WI
53212-2709
US

IV. Provider business mailing address

2555 N DR MARTIN LUTHER KING JR DR
MILWAUKEE WI
53212-2709
US

V. Phone/Fax

Practice location:
  • Phone: 414-267-2021
  • Fax: 414-372-7420
Mailing address:
  • Phone: 414-267-2021
  • Fax: 414-372-7420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DR. TITO IZARD
Title or Position: PRESIDENT CEO
Credential:
Phone: 414-267-2021