Provider Demographics
NPI:1669032363
Name:MSN CARE
Entity Type:Organization
Organization Name:MSN CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VYACHESLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBROVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:APNP BC
Authorized Official - Phone:414-915-6255
Mailing Address - Street 1:12507 N EMILY LN
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-2611
Mailing Address - Country:US
Mailing Address - Phone:414-915-6255
Mailing Address - Fax:
Practice Address - Street 1:9330 W LINCOLN AVE STE 10
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2300
Practice Address - Country:US
Practice Address - Phone:414-366-2985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-17
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1669032363OtherNPI