Provider Demographics
NPI:1477023729
Name:SUBDOC
Entity Type:Organization
Organization Name:SUBDOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHELSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-467-8884
Mailing Address - Street 1:7275 N PORT WASHINGTON RD APT 314
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-3337
Mailing Address - Country:US
Mailing Address - Phone:414-467-8884
Mailing Address - Fax:
Practice Address - Street 1:7275 N PORT WASHINGTON RD APT 314
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53217-3337
Practice Address - Country:US
Practice Address - Phone:414-467-8884
Practice Address - Fax:414-435-3126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-29
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearchGroup - Multi-Specialty