Healthcare Provider Details

I. General information

NPI: 1235434366
Provider Name (Legal Business Name): CENTRAL MEDICAL CLINIC, S.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2011
Last Update Date: 03/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 W CENTER ST SUITE 104
MILWAUKEE WI
53210-2154
US

IV. Provider business mailing address

6001 W CENTER ST SUITE 104
MILWAUKEE WI
53210-2154
US

V. Phone/Fax

Practice location:
  • Phone: 414-447-8499
  • Fax: 414-763-1674
Mailing address:
  • Phone: 414-447-8499
  • Fax: 414-763-1674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GEOFFREY NKWAZI
Title or Position: PRESIDENT
Credential: MD
Phone: 414-447-8499