Provider Demographics
NPI:1457528838
Name:ST LUK4ES MEDICAL CENTER
Entity Type:Organization
Organization Name:ST LUK4ES MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:HAFERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-529-9289
Mailing Address - Street 1:3738 S 60TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53220-1935
Mailing Address - Country:US
Mailing Address - Phone:414-546-5460
Mailing Address - Fax:
Practice Address - Street 1:1055 KATHERINE DR
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2152
Practice Address - Country:US
Practice Address - Phone:262-784-1484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AURORA HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1440-24282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40070300Medicaid