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NPI Code Detail

MEDICARE: MILWAUKEE HEALTH SERVICES, INC.

MEDICARE: MILWAUKEE HEALTH SERVICES, 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
1333600000XPharmacy
23336C0002XClinic Pharmacy8664042WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12110937OTHERPK

General Provider Information

NPI Number : 1376570663
Entity Type Code : Organization
Provider Name (Legal Business Name) : MILWAUKEE HEALTH SERVICES, INC.
Provider Business Mailing Address
First Line : 2555 N MARTIN LUTHER KING DR
Second Line :
City : MILWAUKEE
State : WI
Zip : 53212-2709
Country : US
Telephone Number : 414-372-8080
Fax Number :
Provider Business Practice Location Address
First Line : 8200 W SILVER SPRING DR
Second Line :
City : MILWAUKEE
State : WI
Zip : 53218-2552
Country : US
Telephone Number : 414-760-3922
Fax Number : 414-464-6184
Authorized Official
Title or Position : PRESIDENT CEO
Name : TITO IZARD
Credential : MD
Telephone Number : 414-267-2021
Provider Enumeration Date : 06/26/2006
Last Update Date : 09/16/2016

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