Provider Demographics
NPI:1346882693
Name:MY HEALTH CLINIC CORP
Entity Type:Organization
Organization Name:MY HEALTH CLINIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AAILA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELAHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-248-1238
Mailing Address - Street 1:S76W20310 HILLENDALE DR
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-9526
Mailing Address - Country:US
Mailing Address - Phone:414-248-1238
Mailing Address - Fax:414-448-6848
Practice Address - Street 1:7235 W APPLETON AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1932
Practice Address - Country:US
Practice Address - Phone:414-800-9924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-08
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1023562758Medicaid
WI1457666315Medicaid
WI1457666315Medicaid