| Lisbon Avenue Health Center | |
|
3522 W Lisbon Ave Milwaukee WI 53208-1953 | |
| (414) 935-8000 | |
| (414) 344-3396 |
| Full Name | Lisbon Avenue Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 3522 W Lisbon Ave, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Candice Cole (CFO) |
| Authorized Official Contact | 4149358000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lisbon Avenue Health Center Po Box 080257 Milwaukee WI 53208-8004 Ph: (414) 935-8000 | Lisbon Avenue Health Center 3522 W Lisbon Ave Milwaukee WI 53208-1953 Ph: (414) 935-8000 |
| NPI Number | 1720153653 |
|---|---|
| Provider Enumeration Date | 11/24/2006 |
| Last Update Date | 01/25/2017 |
| Medicare PECOS PAC ID | 2466366059 |
|---|---|
| Medicare Enrollment ID | O20031118000358 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720153653 | NPI | - | NPPES |
| 32957400 | Medicaid | WI |
| Provider Name | Michael E Belete |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811075328 PECOS PAC ID: 0042298051 Enrollment ID: I20040707001351 |
| Provider Name | George A Idarraga |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1487699674 PECOS PAC ID: 4587608146 Enrollment ID: I20050614001147 |
| Provider Name | Allison M Kos |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518916931 PECOS PAC ID: 7214935352 Enrollment ID: I20061128000048 |
| Provider Name | Madelaine T Tully |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255419784 PECOS PAC ID: 6709977473 Enrollment ID: I20070809000463 |
| Provider Name | Jyothi Veeramachaneni |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134274095 PECOS PAC ID: 4789751157 Enrollment ID: I20080926000371 |
| Provider Name | Annette Stokes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801956214 PECOS PAC ID: 5890838395 Enrollment ID: I20100208000462 |
| Provider Name | Tia C Medley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609182161 PECOS PAC ID: 5395927552 Enrollment ID: I20110309000172 |
| Provider Name | Emily M Siegrist |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134442239 PECOS PAC ID: 9234388174 Enrollment ID: I20121009000374 |
| Provider Name | Lisa Hudson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437408606 PECOS PAC ID: 5496999864 Enrollment ID: I20130925000377 |
| Provider Name | Laleh Karimi |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1518195395 PECOS PAC ID: 9335371533 Enrollment ID: I20140422000097 |
| Provider Name | Joseph A Rebro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699192104 PECOS PAC ID: 4880817162 Enrollment ID: I20140514002087 |
| Provider Name | Rabany Clayborn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003163460 PECOS PAC ID: 6507161528 Enrollment ID: I20160229001305 |
| Provider Name | Meagan Thielecke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427416858 PECOS PAC ID: 7113224692 Enrollment ID: I20160329000000 |
| Provider Name | Amy Shay |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1780021642 PECOS PAC ID: 1254622517 Enrollment ID: I20160617000221 |
| Provider Name | Ana M Sanchez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053869305 PECOS PAC ID: 8527356583 Enrollment ID: I20161007000703 |
| Provider Name | Nicole Wooters |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699228080 PECOS PAC ID: 5991089294 Enrollment ID: I20170306001835 |
| Provider Name | Courtney L Schmitz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972058824 PECOS PAC ID: 3577847714 Enrollment ID: I20170307000926 |
| Provider Name | Whitney Sickler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609268770 PECOS PAC ID: 9133403280 Enrollment ID: I20170309000432 |
| Provider Name | Smriti Madrecha |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1508382276 PECOS PAC ID: 2062787203 Enrollment ID: I20171013001840 |
| Provider Name | Shayla Jefferson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669926564 PECOS PAC ID: 4880975200 Enrollment ID: I20171201002010 |
| Provider Name | Reyna G Garcia |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1760830228 PECOS PAC ID: 0042502833 Enrollment ID: I20180301000429 |
| Provider Name | Theresa Gray |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1386025377 PECOS PAC ID: 2860756145 Enrollment ID: I20180514003038 |
| Provider Name | Erin Gillespie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568938207 PECOS PAC ID: 3779827902 Enrollment ID: I20181220002268 |
| Provider Name | Joshua David Spierer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538712658 PECOS PAC ID: 7113253873 Enrollment ID: I20190801003095 |
| Provider Name | Toni Delagardelle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477106730 PECOS PAC ID: 5597092486 Enrollment ID: I20190815001402 |
| Provider Name | Jason Holt |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1588103097 PECOS PAC ID: 8325383011 Enrollment ID: I20190913002054 |
| Provider Name | Julie Marie Grachan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447694518 PECOS PAC ID: 4688963010 Enrollment ID: I20191024000350 |
| Provider Name | Mary E. Clementi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346896594 PECOS PAC ID: 5395077309 Enrollment ID: I20191024000474 |
| Provider Name | Tiagan T Dahl |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801312491 PECOS PAC ID: 7315370491 Enrollment ID: I20191203002220 |
| Provider Name | Elizabeth Halley Finseth |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1699060806 PECOS PAC ID: 4880818368 Enrollment ID: I20200124001208 |
| Provider Name | Benjamin Salazar Yabut |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1215915194 PECOS PAC ID: 9537428446 Enrollment ID: I20200416001279 |
| Provider Name | Raymundo Garcia-dwyer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427406032 PECOS PAC ID: 0244565208 Enrollment ID: I20200921002942 |
| Provider Name | Max Carpenter |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1508492885 PECOS PAC ID: 0547689440 Enrollment ID: I20200925001709 |
| Provider Name | Alexandra Steininger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972080786 PECOS PAC ID: 0345584801 Enrollment ID: I20210512001754 |
| Provider Name | Magdelyn Marie Mueller |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1356910293 PECOS PAC ID: 9931503539 Enrollment ID: I20210804001208 |
| Provider Name | Morgan Altinok |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1093247181 PECOS PAC ID: 8628322039 Enrollment ID: I20210827001433 |
| Provider Name | Jonetta Bracken |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184144123 PECOS PAC ID: 5890169676 Enrollment ID: I20230317000432 |
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