Provider Demographics
NPI:1518260843
Name:CITY OF MILWAUKEE HEALTH DEPT
Entity Type:Organization
Organization Name:CITY OF MILWAUKEE HEALTH DEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMISSIONER OF HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:BEVAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:414-286-3521
Mailing Address - Street 1:841 N BROADWAY FL 3
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3639
Mailing Address - Country:US
Mailing Address - Phone:414-286-3569
Mailing Address - Fax:414-286-5990
Practice Address - Street 1:841 N BROADWAY 3RD FLOOR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-3639
Practice Address - Country:US
Practice Address - Phone:414-286-3521
Practice Address - Fax:414-286-5990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32914800Medicaid
WI43089300Medicaid
WI44015500Medicaid
WI41855700Medicaid
WI000082137Medicare UPIN
WI41855700Medicaid