| Southeastern Family Practice Sc | |
|
1308 S 16th St Milwaukee WI 53204-2711 | |
| (414) 831-0100 | |
| (414) 831-1584 |
| Full Name | Southeastern Family Practice Sc |
|---|---|
| Speciality | Pediatrics - Adolescent Medicine |
| Location | 1308 S 16th St, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Noemi A Prieto (PRESIDENT) |
| Authorized Official Contact | 4144636640 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeastern Family Practice Sc 8532 W Capitol Dr Milwaukee WI 53222-1848 Ph: (414) 463-6640 | Southeastern Family Practice Sc 1308 S 16th St Milwaukee WI 53204-2711 Ph: (414) 831-0100 |
| NPI Number | 1134303621 |
|---|---|
| Provider Enumeration Date | 12/20/2007 |
| Last Update Date | 12/20/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134303621 | NPI | - | NPPES |
| 30718400 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 48505 (Wisconsin) | Secondary |
| 2080A0000X | Pediatrics - Adolescent Medicine | 26529 (Wisconsin) | Primary |
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