| Gerald L. Ignace Indian Health Center, Inc. | |
|
930 W Historic Mitchell St Milwaukee WI 53204-3533 | |
| (414) 383-9526 | |
| (414) 649-6711 |
| Full Name | Gerald L. Ignace Indian Health Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 930 W Historic Mitchell St, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Lyle A. Ignace (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4143839526 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gerald L. Ignace Indian Health Center, Inc. 1711 South 11th Street Milwaukee WI 53204-3310 Ph: (414) 383-9526 | Gerald L. Ignace Indian Health Center, Inc. 930 W Historic Mitchell St Milwaukee WI 53204-3533 Ph: (414) 383-9526 |
| NPI Number | 1023064086 |
|---|---|
| Provider Enumeration Date | 05/25/2006 |
| Last Update Date | 03/13/2020 |
| Medicare PECOS PAC ID | 5799677282 |
|---|---|
| Medicare Enrollment ID | O20040329000847 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023064086 | NPI | - | NPPES |
| 093488131 | Other | WI | CHAMPUS |
| 32957100 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Paul D Ginkel |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1033184759 PECOS PAC ID: 1355238379 Enrollment ID: I20040319001218 |
| Provider Name | U Michael Blaschke |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437111762 PECOS PAC ID: 8325036221 Enrollment ID: I20040430001086 |
| Provider Name | Hugo F Goitia |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1417121153 PECOS PAC ID: 5597715946 Enrollment ID: I20050125000034 |
| Provider Name | Mustansir Majeed |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689778920 PECOS PAC ID: 0749230415 Enrollment ID: I20050131000361 |
| Provider Name | Bridget M Costigan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295084341 PECOS PAC ID: 2567613375 Enrollment ID: I20121102000492 |
| Provider Name | Angeline Vercauteren |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407287543 PECOS PAC ID: 6305076290 Enrollment ID: I20140219001793 |
| Provider Name | Lyle Ignace |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649209545 PECOS PAC ID: 5597755918 Enrollment ID: I20140402000044 |
| Provider Name | Kristine I Fleis |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1598065559 PECOS PAC ID: 2062717846 Enrollment ID: I20160217000640 |
| Provider Name | Lydia Biehr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023542933 PECOS PAC ID: 5799044624 Enrollment ID: I20180122001677 |
| Provider Name | Ellicia Wilder |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1861156473 PECOS PAC ID: 6406299924 Enrollment ID: I20240212001792 |
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