Healthcare Provider Details

I. General information

NPI: 1861437766
Provider Name (Legal Business Name): OMNI FAMILY MEDICAL CLINIC URGENT CARE, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7810 W GOOD HOPE RD
MILWAUKEE WI
53223-4518
US

IV. Provider business mailing address

7810 W GOOD HOPE RD
MILWAUKEE WI
53223-4518
US

V. Phone/Fax

Practice location:
  • Phone: 414-586-9255
  • Fax: 414-586-9282
Mailing address:
  • Phone: 414-586-9255
  • Fax: 414-586-9282

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: DR. ABALO K. ELI NUNYAKPE
Title or Position: CEO/MEDICAL DIRECTOR
Credential: M.D.
Phone: 414-586-9255