Healthcare Provider Details

I. General information

NPI: 1194083410
Provider Name (Legal Business Name): PROCARE URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 04/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 W WISCONSIN AVE SUITE 2
MILWAUKEE WI
53208-3182
US

IV. Provider business mailing address

3727 W WISCONSIN AVE
MILWAUKEE WI
53208-3182
US

V. Phone/Fax

Practice location:
  • Phone: 414-291-2626
  • Fax: 414-431-0050
Mailing address:
  • Phone: 414-291-2626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHAKAIB M RAZZAQ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 414-291-2626