Provider Demographics
NPI:1043474315
Name:FAMILY CARE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:FAMILY CARE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIO
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:ILADA
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:262-598-9205
Mailing Address - Street 1:5439 DURAND AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-5058
Mailing Address - Country:US
Mailing Address - Phone:262-598-9205
Mailing Address - Fax:
Practice Address - Street 1:5439 DURAND AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-5058
Practice Address - Country:US
Practice Address - Phone:262-598-9205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35992-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty