Healthcare Provider Details

I. General information

NPI: 1447657739
Provider Name (Legal Business Name): GERALD L. IGNACE INDIAN HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2014
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 W HISTORIC MITCHELL ST
MILWAUKEE WI
53204-3533
US

IV. Provider business mailing address

930 W HISTORIC MITCHELL ST
MILWAUKEE WI
53204-3533
US

V. Phone/Fax

Practice location:
  • Phone: 414-383-9526
  • Fax: 414-389-3881
Mailing address:
  • Phone: 414-383-9526
  • Fax: 414-389-3881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number3040
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. LYLE A IGNACE
Title or Position: EXECUTIVE DIRECTOR
Credential: M.D., M.P.H.
Phone: 414-383-9526