Provider Demographics
NPI:1508940255
Name:COMPREHENSIVE GENETIC SERVICES, SC
Entity Type:Organization
Organization Name:COMPREHENSIVE GENETIC SERVICES, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRYKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-393-1000
Mailing Address - Street 1:3720 N 124TH ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-2100
Mailing Address - Country:US
Mailing Address - Phone:414-393-1000
Mailing Address - Fax:414-393-1399
Practice Address - Street 1:3720 N 124TH ST
Practice Address - Street 2:SUITE I
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-2100
Practice Address - Country:US
Practice Address - Phone:414-393-1000
Practice Address - Fax:414-393-1399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33237207SC0300X, 207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)Group - Multi-Specialty
No207SC0300XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical CytogeneticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32516200Medicaid
WI2132702001OtherAMERICHOICE
WI120003406OtherWEA
WI5241745OtherAETNA
WI6344590OtherABRI
WI32516200OtherMANAGED HEALTH
WI7400178OtherUNITED HEALTH CARE
WI072446202OtherTRICARE
WI32516200OtherMANAGED HEALTH
WI7400178OtherUNITED HEALTH CARE
WI=========014OtherANTHEM BLUE CROSS COMPCA
WI32516200Medicaid
WI120003406OtherWEA
WI370021631Medicare PIN
WI=========002OtherCIGNA
WI120003406OtherWEA