Provider Demographics
NPI:1790323608
Name:SOLIDARITUS HEALTH WISCONSIN SC
Entity Type:Organization
Organization Name:SOLIDARITUS HEALTH WISCONSIN SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPSA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:202-256-4116
Mailing Address - Street 1:1025 CONNECTICUT AVE NW STE 907
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-5434
Mailing Address - Country:US
Mailing Address - Phone:202-256-4116
Mailing Address - Fax:
Practice Address - Street 1:1476 BLAZING STAR BLVD STE 4
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-4002
Practice Address - Country:US
Practice Address - Phone:202-254-4116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty