Healthcare Provider Details

I. General information

NPI: 1174323836
Provider Name (Legal Business Name): AUTHENTIC BIRTH CENTER WELLNESS COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N 108TH PL STE 100
WAUWATOSA WI
53226-4253
US

IV. Provider business mailing address

2864 S WAUKESHA RD
WEST ALLIS WI
53227-2834
US

V. Phone/Fax

Practice location:
  • Phone: 414-231-9640
  • Fax: 414-226-5078
Mailing address:
  • Phone: 414-617-3178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TONY SKARLATOS
Title or Position: COO
Credential:
Phone: 414-617-3178