Healthcare Provider Details

I. General information

NPI: 1528344827
Provider Name (Legal Business Name): CISERO TRANSPORTATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2011
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8127 W BRENTWOOD AVE
MILWAUKEE WI
53223-5528
US

IV. Provider business mailing address

8127 W BRENTWOOD AVE
MILWAUKEE WI
53223-5528
US

V. Phone/Fax

Practice location:
  • Phone: 414-897-2667
  • Fax:
Mailing address:
  • Phone: 414-897-2667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number1234567
License Number StateWI

VIII. Authorized Official

Name: LYDELL HUNTER
Title or Position: OWNER
Credential:
Phone: 414-897-2667