Healthcare Provider Details

I. General information

NPI: 1063942985
Provider Name (Legal Business Name): DEAFRICA MILTON ALEXANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 06/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 N 67TH ST
MILWAUKEE WI
53216-2728
US

IV. Provider business mailing address

107 W BROWN ST
MILWAUKEE WI
53212-3714
US

V. Phone/Fax

Practice location:
  • Phone: 262-527-1282
  • Fax: 262-527-1282
Mailing address:
  • Phone: 414-501-0926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: