| Brotoloc South, Inc. | |
|
5812 W Burnham St West Allis WI 53219-1524 | |
| (414) 543-3200 | |
| (414) 543-3269 |
| Full Name | Brotoloc South, Inc. |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 5812 W Burnham St, West Allis, Wisconsin |
| Authorized Official Name and Position | Doug E Sveda (DIRECTOR) |
| Authorized Official Contact | 4145433200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Brotoloc South, Inc. 5812 W Burnham St West Allis WI 53219-1524 Ph: (414) 543-3200 | Brotoloc South, Inc. 5812 W Burnham St West Allis WI 53219-1524 Ph: (414) 543-3200 |
| NPI Number | 1982933503 |
|---|---|
| Provider Enumeration Date | 12/10/2009 |
| Last Update Date | 04/26/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982933503 | NPI | - | NPPES |
| 42207400 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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