| Humboldt Ridge Dialysis Center | |
|
2211 N Humboldt Blvd Milwaukee WI 53212-3507 | |
| (414) 336-7200 | |
| (414) 777-5210 |
| Full Name | Humboldt Ridge Dialysis Center |
|---|---|
| Speciality | Clinic/center |
| Location | 2211 N Humboldt Blvd, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Barry Lee Luckenbill (MANAGING MEMBER) |
| Authorized Official Contact | 4147775200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Humboldt Ridge Dialysis Center 2514 S 102nd St Suite 120 West Allis WI 53227-2142 Ph: (414) 777-5200 | Humboldt Ridge Dialysis Center 2211 N Humboldt Blvd Milwaukee WI 53212-3507 Ph: (414) 336-7200 |
| NPI Number | 1043491194 |
|---|---|
| Provider Enumeration Date | 11/16/2007 |
| Last Update Date | 12/27/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043491194 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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