Healthcare Provider Details

I. General information

NPI: 1841434644
Provider Name (Legal Business Name): AURORA ST. LUKE'S MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 04/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W OKLAHOMA AVE
MILWAUKEE WI
53215-4330
US

IV. Provider business mailing address

2900 W OKLAHOMA AVE
MILWAUKEE WI
53215-4330
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-3323
  • Fax:
Mailing address:
  • Phone: 414-649-3323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number390200000X
License Number StateWI

VIII. Authorized Official

Name: KAREN WISE-ACKER
Title or Position: COORDINATOR TRANSITIONAL YEAR RESID
Credential:
Phone: 414-649-3323