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General NPI Number Information
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NPI Number | 1518005818
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Entity Type | Organization
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Legal Business Name | MILWAUKEE HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 06/18/2021
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Provider Practice Location Address
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Address Line | 2555 N DR MARTIN LUTHER KING DR
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City | MILWAUKEE
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State | WI
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Zip | 53212-2709
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Country | US
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Telephone | 414-267-2021
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Fax | 414-372-7420
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Provider Business Mailing Address
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Address Line | 2555 N DR MARTIN LUTHER KING JR DR
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City | MILWAUKEE
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State | WI
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Zip | 53212-2709
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Country | US
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Telephone | 414-267-2021
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Fax | 414-372-7420
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | DR. TITO IZARD
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Credential |
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Telephone | 414-267-2021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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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 | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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