Provider Demographics
NPI:1033302229
Name:MILWAUKEE CENTER FOR INDEPENDENCE
Entity Type:Organization
Organization Name:MILWAUKEE CENTER FOR INDEPENDENCE
Other - Org Name:WHOLE HEALTH CLINICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-937-2108
Mailing Address - Street 1:2020 W WELLS ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-2720
Mailing Address - Country:US
Mailing Address - Phone:414-476-9675
Mailing Address - Fax:414-755-1834
Practice Address - Street 1:2020 W WELLS ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-2720
Practice Address - Country:US
Practice Address - Phone:414-476-9675
Practice Address - Fax:414-755-1834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2125251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43426400Medicaid