Healthcare Provider Details

I. General information

NPI: 1861682411
Provider Name (Legal Business Name): MANAGED HEALTH SERVICES INSURANCE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S 60TH ST
WEST ALLIS WI
53214-9800
US

IV. Provider business mailing address

1205 S 70TH ST
WEST ALLIS WI
53214-3167
US

V. Phone/Fax

Practice location:
  • Phone: 414-345-4620
  • Fax: 414-259-2153
Mailing address:
  • Phone: 414-345-4620
  • Fax: 414-259-2153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberHMO 69002400
License Number StateWI

VIII. Authorized Official

Name: KENNETH KOSHOREK
Title or Position: STAFF VICE PRESIDENT
Credential:
Phone: 313-720-5567