Provider Demographics
NPI:1881906832
Name:CLEMENT ZABLOCKI VETERAN'S ADMINISTRATION MEDICAL CENTER
Entity type:Organization
Organization Name:CLEMENT ZABLOCKI VETERAN'S ADMINISTRATION MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCI OUTPATIENT CLINIC RN
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNKEL
Authorized Official - Suffix:
Authorized Official - Credentials:RN , BSN
Authorized Official - Phone:414-384-2000
Mailing Address - Street 1:5000 W NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53295-0001
Mailing Address - Country:US
Mailing Address - Phone:414-384-2000
Mailing Address - Fax:414-382-5293
Practice Address - Street 1:5000 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53295-0001
Practice Address - Country:US
Practice Address - Phone:414-384-2000
Practice Address - Fax:414-382-5293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI126285-30261QV0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA