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General NPI Number Information
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NPI Number | 1447657739
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Entity Type | Organization
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Legal Business Name | GERALD L. IGNACE INDIAN HEALTH CENTER, INC.
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Dates
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Enumeration Date | 12/02/2014
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 930 W HISTORIC MITCHELL ST
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City | MILWAUKEE
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State | WI
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Zip | 53204-3533
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Country | US
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Telephone | 414-383-9526
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Fax | 414-389-3881
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Provider Business Mailing Address
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Address Line | 930 W HISTORIC MITCHELL ST
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City | MILWAUKEE
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State | WI
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Zip | 53204-3533
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Country | US
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Telephone | 414-383-9526
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Fax | 414-389-3881
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. LYLE A IGNACE
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Credential | M.D., M.P.H.
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Telephone | 414-383-9526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 3040
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License Number State | WI
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