Provider Demographics
NPI:1508081134
Name:MISLINSKI-ZOSEL S.C.
Entity Type:Organization
Organization Name:MISLINSKI-ZOSEL S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOSEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:262-784-6628
Mailing Address - Street 1:8961 W PALMETTO CT
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-5017
Mailing Address - Country:US
Mailing Address - Phone:414-536-8604
Mailing Address - Fax:414-536-8605
Practice Address - Street 1:250 N SUNNY SLOPE RD STE 129
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4815
Practice Address - Country:US
Practice Address - Phone:262-784-6628
Practice Address - Fax:414-536-8605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI=========016OtherBLUE CROSS BLUE SHIELD