MEDICARE: BLUE SKIES HOLISTIC CARE, INC.

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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1225709587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE SKIES HOLISTIC CARE, INC.

Provider Business Mailing Address
First Line	:	20515 MILTON CT
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53045-4050
Country	:	US
Telephone Number	:	414-737-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	9205 W CENTER ST STE 209
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-4548
Country	:	US
Telephone Number	:	414-737-6000
Fax Number	:	414-677-6979

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KELEMARIE R LYONS
Credential	:	LAC
Telephone Number	:	414-737-6000

Provider Enumeration Date	:	09/25/2021
Last Update Date	:	06/23/2023

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