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NPI Code Detail

MEDICARE: VALERIE BLACK PA-C

MEDICARE: VALERIE BLACK PA-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
1363A00000XPhysician Assistant502WI

Other Identifiers

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

General Provider Information

NPI Number : 1710933957
Entity Type Code : Individual
Provider Name (Legal Business Name) : VALERIE BLACK PA-C
Provider Business Mailing Address
First Line : 1218 W KILBOURN AVE
Second Line : SUITE 301
City : MILWAUKEE
State : WI
Zip : 53233-1330
Country : US
Telephone Number : 414-276-6000
Fax Number : 414-276-1758
Provider Business Practice Location Address
First Line : 1218 W KILBOURN AVE
Second Line : SUITE 301
City : MILWAUKEE
State : WI
Zip : 53233-1330
Country : US
Telephone Number : 414-276-6000
Fax Number : 414-276-1758
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2006
Last Update Date : 11/23/2021

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Directions to “ VALERIE BLACK PA-C” Practice Location

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