| Thousand Mile Journey Llc | |
|
10501 W Research Drive Suite G200 Milwaukee WI 53226-3444 | |
| (414) 543-3333 | |
| (414) 302-1040 |
| Full Name | Thousand Mile Journey Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 10501 W Research Drive, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Anne Ania Person (PRESIDENT) |
| Authorized Official Contact | 4145433333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Thousand Mile Journey Llc 10501 W Research Dr Suite G200 Milwaukee WI 53226-3449 Ph: (414) 543-3333 | Thousand Mile Journey Llc 10501 W Research Drive Suite G200 Milwaukee WI 53226-3444 Ph: (414) 543-3333 |
| NPI Number | 1699159962 |
|---|---|
| Provider Enumeration Date | 07/16/2015 |
| Last Update Date | 03/22/2016 |
| Medicare PECOS PAC ID | 5991019937 |
|---|---|
| Medicare Enrollment ID | O20150804004280 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699159962 | NPI | - | NPPES |
| 1699159962 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 3110-33 (Wisconsin) | Primary |
| Provider Name | Michael J Gerard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598742652 PECOS PAC ID: 6507897261 Enrollment ID: I20050823000676 |
| Provider Name | Anne A Person |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801953948 PECOS PAC ID: 2961592886 Enrollment ID: I20071217000048 |
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