Healthcare Provider Details

I. General information

NPI: 1396180725
Provider Name (Legal Business Name): ZABLOCKI VA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2013
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W NATIONAL AVE
MILWAUKEE WI
53295-0001
US

IV. Provider business mailing address

5000 W NATIONAL AVE
MILWAUKEE WI
53295-0001
US

V. Phone/Fax

Practice location:
  • Phone: 414-384-2000
  • Fax: 414-382-5298
Mailing address:
  • Phone: 414-384-2000
  • Fax: 414-382-5298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES ANTHONY HEALY BONANNO
Title or Position: VOCATIONAL REHABILITATION COUNSELOR
Credential: MS, LPC, CVE
Phone: 414-384-2000