Healthcare Provider Details

I. General information

NPI: 1497768659
Provider Name (Legal Business Name): WISCONSIN HEALTH FUND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 W BLUEMOUND RD
MILWAUKEE WI
53213-4145
US

IV. Provider business mailing address

6200 W BLUEMOUND RD
MILWAUKEE WI
53213-4145
US

V. Phone/Fax

Practice location:
  • Phone: 414-771-5600
  • Fax: 414-476-9988
Mailing address:
  • Phone: 414-771-5600
  • Fax: 414-476-9988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL SCOTT LOVELY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 414-771-5600