MEDICARE: M.C. PREPARATORY SCHOOL OF WISCONSIN 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	251300000X	Local Education Agency (LEA)		WI

General Provider Information

NPI Number	:	1275088981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M.C. PREPARATORY SCHOOL OF WISCONSIN INC

Provider Business Mailing Address
First Line	:	1228 W LLOYD ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53205-1243
Country	:	US
Telephone Number	:	414-264-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1228 W LLOYD ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53205-1243
Country	:	US
Telephone Number	:	414-264-6000
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	JON OSMAN
Credential	:
Telephone Number	:	414-264-6000

Provider Enumeration Date	:	08/23/2016
Last Update Date	:	08/23/2016

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