Healthcare Provider Details

I. General information

NPI: 1871244699
Provider Name (Legal Business Name): MKE CLIA SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4911 W GOOD HOPE RD STE 103
MILWAUKEE WI
53223-4840
US

IV. Provider business mailing address

4911 W GOOD HOPE RD STE 103
MILWAUKEE WI
53223-4840
US

V. Phone/Fax

Practice location:
  • Phone: 414-885-3709
  • Fax: 414-306-6426
Mailing address:
  • Phone: 414-885-3709
  • Fax: 414-306-6426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MS. FELICIA LATORIA ALSTORK
Title or Position: CEO
Credential: RN
Phone: 414-885-3709