MEDICARE: ST.MICHAEL HOSPITAL

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	282N00000X	General Acute Care Hospital	54	WI

Other Identifiers

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

General Provider Information

NPI Number	:	1417923020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST.MICHAEL HOSPITAL

Provider Business Mailing Address
First Line	:	2400 W VILLARD AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-4901
Country	:	US
Telephone Number	:	414-527-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 W VILLARD AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-4901
Country	:	US
Telephone Number	:	414-527-8000
Fax Number	:

Authorized Official
Title or Position	:	VP FINANCIAL OPERATIONS
Name	:	MR. JON W SOHN
Credential	:
Telephone Number	:	414-465-3090

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	01/11/2010

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Directions to “ST.MICHAEL HOSPITAL ” Practice Location

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