MEDICARE: COUNTY OF MILWAUKEE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	283Q00000X	Psychiatric Hospital	229	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000812	OTHER	WI	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083728612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF MILWAUKEE

Provider Business Mailing Address
First Line	:	1220 W VLIET ST FL 3
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53205-2117
Country	:	US
Telephone Number	:	414-257-6995
Fax Number	:

Provider Business Practice Location Address
First Line	:	9455 W WATERTOWN PLANK RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-3559
Country	:	US
Telephone Number	:	414-257-6995
Fax Number	:

Authorized Official
Title or Position	:	PATIENT ACCOUNTS MANAGER
Name	:	MS. SHERI DUQUAINE
Credential	:
Telephone Number	:	414-391-8172

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	04/13/2023

Similar Medicare Providers

1386756096 — MEGAN ELISE MCCLYMONDS MD
Practice Location Address:

9455 W WATERTOWN PLANK ROAD , MILWAUKEE COUNTY BEHAVIORAL HEALTH DIVISION
MILWAUKEE, WI
53226-3559

Practice Phone: 414-257-6995
Practice Fax:

1538271242 — MRS. CHARLENE ANN WERNER MSN APNP
Practice Location Address:

9455 W WATERTOWN PLANK RD , MILWAUKEE COUNTY BEHAVIORAL HEALTH DIVISION
MILWAUKEE, WI
53226-3559

Practice Phone: 414-257-6995
Practice Fax:

1952413122 — MS. CAROL A ESTHERCHILD MS APNP PMH-NP
Practice Location Address:

9455 W. WATERTOWN PLANK ROAD , MILWAUKEE COUNTY BEHAVIORAL HEALTH DIVISION
MILWAUKEE, WI
53226-3559

Practice Phone: 414-257-6995
Practice Fax:

1841301389 — DR. JUNG-KI CHO M.D.,
Practice Location Address:

9455 W WATERTOWN PLANK RD
MILWAUKEE, WI
53226-3559

Practice Phone: 414-257-4711
Practice Fax:

1215049077 — DR. GEORGE MOLEMO MONESE MD
Practice Location Address:

9455 W WATERTOWN PLANK RD
MILWAUKEE, WI
53226-3559

Practice Phone: 414-257-7260
Practice Fax:

1760584973 — DR. DOUGLAS MARK HARDY PHD
Practice Location Address:

9455 W WATERTOWN PLANK RD , MILWAUKEE COUNTY BEHAVIORAL HEALTH DIVISION
MILWAUKEE, WI
53226-3559

Practice Phone: 414-257-6995
Practice Fax:

Directions to “COUNTY OF MILWAUKEE ” Practice Location

Language	Start Address	Practice Location

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