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NPI Code Detail

MEDICARE: IRIS HEALTH CLINIC

MEDICARE: IRIS HEALTH CLINIC
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
1101Y00000XCounselor
2101YA0400XAddiction (Substance Use Disorder) Counselor
3207QA0401XAddiction Medicine (Family Medicine) Physician
4261Q00000XClinic/Center
5261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center
6291U00000XClinical Medical Laboratory
7261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1942735766
Entity Type Code : Organization
Provider Name (Legal Business Name) : IRIS HEALTH CLINIC
Provider Business Mailing Address
First Line : 255 W BROADWAY
Second Line :
City : WAUKESHA
State : WI
Zip : 53186-4832
Country : US
Telephone Number : 262-420-9088
Fax Number : 262-458-4102
Provider Business Practice Location Address
First Line : 255 W BROADWAY
Second Line :
City : WAUKESHA
State : WI
Zip : 53186-4832
Country : US
Telephone Number : 262-420-9088
Fax Number : 262-458-4102
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : PETER BRUNZELLE
Credential :
Telephone Number : 262-420-9088
Provider Enumeration Date : 04/30/2017
Last Update Date : 05/22/2023

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