Provider Demographics
NPI:1376675512
Name:INNOVATIVE HEALTH CARE, S.C.
Entity Type:Organization
Organization Name:INNOVATIVE HEALTH CARE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-874-5000
Mailing Address - Street 1:5050 W BROWN DEER RD
Mailing Address - Street 2:
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53223-2424
Mailing Address - Country:US
Mailing Address - Phone:414-874-5000
Mailing Address - Fax:414-874-5012
Practice Address - Street 1:5050 W BROWN DEER RD
Practice Address - Street 2:
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53223-2424
Practice Address - Country:US
Practice Address - Phone:414-874-5000
Practice Address - Fax:414-874-5012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32898600Medicaid
WI32898600Medicaid