MEDICARE: MEDICAL CARE INNOVATION, P.C.

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1548115272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL CARE INNOVATION, P.C.

Provider Business Mailing Address
First Line	:	W227N6103 SUSSEX RD
Second Line	:
City	:	SUSSEX
State	:	WI
Zip	:	53089-3969
Country	:	US
Telephone Number	:	414-566-8400
Fax Number	:	414-566-8400

Provider Business Practice Location Address
First Line	:	4081 TAMIAMI TRL N STE C203
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34103-3573
Country	:	US
Telephone Number	:	414-566-8400
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	ROBERT L POULSEN
Credential	:
Telephone Number	:	414-566-8400

Provider Enumeration Date	:	02/27/2026
Last Update Date	:	02/27/2026

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