Provider Demographics
NPI:1659764454
Name:MILWAUKEE MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:MILWAUKEE MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MANEE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-405-7506
Mailing Address - Street 1:5626 N 91ST ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-2745
Mailing Address - Country:US
Mailing Address - Phone:414-323-7566
Mailing Address - Fax:414-323-7161
Practice Address - Street 1:5626 N 91ST ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-2745
Practice Address - Country:US
Practice Address - Phone:414-323-7566
Practice Address - Fax:414-323-7161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-18
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies