Healthcare Provider Details

I. General information

NPI: 1891732244
Provider Name (Legal Business Name): MILWAUKEE HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 W SILVER SPRING DR ATTENTION: TITO IZARD, M.D.
MILWAUKEE WI
53218-2552
US

IV. Provider business mailing address

2555 N MARTIN LUTHER KING 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 Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License NumberN/A
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number8664-42
License Number StateWI

VIII. Authorized Official

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