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2400 W Villard Ave Milwaukee WI 53209-4901 | |
| (414) 527-8191 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 2400 W Villard Ave, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Michael Mccullough (CFO) |
| Authorized Official Contact | 4144653736 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 860004 Minneapolis MN 55486-6000 Ph: (414) 527-8191 | 2400 W Villard Ave Milwaukee WI 53209-4901 Ph: (414) 527-8191 |
| NPI Number | 1952905069 |
|---|---|
| Provider Enumeration Date | 11/30/2020 |
| Last Update Date | 01/21/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952905069 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QR0400X | Clinic/center - Rehabilitation | (* (Not Available)) | Secondary |
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