Provider Demographics
NPI:1033194642
Name:MILWAUKEE FAMILY PRACTICE SC
Entity Type:Organization
Organization Name:MILWAUKEE FAMILY PRACTICE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-546-3400
Mailing Address - Street 1:4931 S 27TH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2652
Mailing Address - Country:US
Mailing Address - Phone:414-546-3400
Mailing Address - Fax:414-546-3500
Practice Address - Street 1:4931 S 27TH ST
Practice Address - Street 2:STE 200
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53221-2652
Practice Address - Country:US
Practice Address - Phone:414-546-3400
Practice Address - Fax:414-546-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32889900Medicaid
WI01903Medicare ID - Type Unspecified