| Westside Healthcare Association Inc | |
|
3522 W Lisbon Ave Milwaukee WI 53208-1953 | |
| (414) 935-8000 | |
| (414) 755-0058 |
| Full Name | Westside Healthcare Association Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 3522 W Lisbon Ave, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Tangela M Poole (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 4149347582 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Westside Healthcare Association Inc 3522 W Lisbon Ave Milwaukee WI 53208-1953 Ph: (414) 935-8000 | Westside Healthcare Association Inc 3522 W Lisbon Ave Milwaukee WI 53208-1953 Ph: (414) 935-8000 |
| NPI Number | 1245490127 |
|---|---|
| Provider Enumeration Date | 06/13/2008 |
| Last Update Date | 06/13/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245490127 | NPI | - | NPPES |
| 32957400 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 4109 (Wisconsin) | Secondary |
| 207Q00000X | Family Medicine | 49433 (Wisconsin) | Primary |
| 363A00000X | Physician Assistant | 2023 (Wisconsin) | Secondary |
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