Provider Demographics
NPI:1942474572
Name:PLANNED PARENTHOOD OF WISCONSIN
Entity Type:Organization
Organization Name:PLANNED PARENTHOOD OF WISCONSIN
Other - Org Name:MILL ROAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR IT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALISTRERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-289-3769
Mailing Address - Street 1:302 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-5904
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7630 W MILL RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-1142
Practice Address - Country:US
Practice Address - Phone:414-760-2916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No332900000XSuppliersNon-Pharmacy Dispensing Site