Provider Demographics
NPI:1275644171
Name:ARA-MILWAUKEE DIALYSIS LLC
Entity Type:Organization
Organization Name:ARA-MILWAUKEE DIALYSIS LLC
Other - Org Name:MILWAUKEE DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF NURSING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-371-7878
Mailing Address - Street 1:4775 N GREEN BAY AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-6521
Mailing Address - Country:US
Mailing Address - Phone:414-265-1700
Mailing Address - Fax:414-265-1701
Practice Address - Street 1:4775 N GREEN BAY AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-6521
Practice Address - Country:US
Practice Address - Phone:414-265-1700
Practice Address - Fax:414-265-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42061800Medicaid
WI42061800Medicaid