Provider Demographics
NPI:1083755177
Name:CURATIVE CARE NETWORK, INC.
Entity Type:Organization
Organization Name:CURATIVE CARE NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:F
Authorized Official - Last Name:JETZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-479-9249
Mailing Address - Street 1:1000 N 92ND ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3533
Mailing Address - Country:US
Mailing Address - Phone:414-479-9249
Mailing Address - Fax:
Practice Address - Street 1:1000 N 92ND ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3533
Practice Address - Country:US
Practice Address - Phone:414-479-9249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X
WI261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41806800Medicaid
WI=========014OtherBLUE CROSS BLUE SHIELD
WI41806800Medicaid