Healthcare Provider Details

I. General information

NPI: 1336371020
Provider Name (Legal Business Name): WISCONSIN HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2009
Last Update Date: 05/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 W. MORELAND BOULAVARD
WAUKESHA WI
53188
US

IV. Provider business mailing address

4131 W LOOMIS RD STE 300
GREENFIELD WI
53221-2057
US

V. Phone/Fax

Practice location:
  • Phone: 414-325-7246
  • Fax: 414-325-3720
Mailing address:
  • Phone: 414-325-7246
  • Fax: 414-325-3720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. VISHAL LAL
Title or Position: CEO
Credential:
Phone: 414-325-7246