Provider Demographics
NPI:1568684058
Name:CITY OF CUDAHY
Entity Type:Organization
Organization Name:CITY OF CUDAHY
Other - Org Name:CUDAHY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAITE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LEPAK
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:414-769-2239
Mailing Address - Street 1:5050 SOUTH LAKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110
Mailing Address - Country:US
Mailing Address - Phone:414-769-2239
Mailing Address - Fax:414-769-2291
Practice Address - Street 1:5050 SOUTH LAKE DRIVE
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:WI
Practice Address - Zip Code:53110
Practice Address - Country:US
Practice Address - Phone:414-769-2239
Practice Address - Fax:414-769-2291
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF CUDAHY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-03
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251K00000X
WI261QF0050X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41863100Medicaid
WI43085000Medicaid
WI44017000Medicaid
WI41863100Medicaid