Provider Demographics
NPI:1881182889
Name:ALLURE MEDICAL OF WISCONSIN PLLC
Entity Type:Organization
Organization Name:ALLURE MEDICAL OF WISCONSIN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:K
Authorized Official - Last Name:MOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-786-5900
Mailing Address - Street 1:8180 26 MILE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-5139
Mailing Address - Country:US
Mailing Address - Phone:586-786-5900
Mailing Address - Fax:586-992-9331
Practice Address - Street 1:1930 W BLUEMOUND RD STE 340
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186
Practice Address - Country:US
Practice Address - Phone:262-349-9371
Practice Address - Fax:262-408-5258
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VEIN CENTER AT ALLURE MEDICAL SPA, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-25
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty