Provider Demographics
NPI:1952199275
Name:IDOC WISCONSIN TELEHEALTH SOLUTIONS LLC
Entity type:Organization
Organization Name:IDOC WISCONSIN TELEHEALTH SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBA
Authorized Official - Prefix:
Authorized Official - First Name:NATALYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELNIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-378-9549
Mailing Address - Street 1:4635 SOUTHWEST FWY STE 525
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7157
Mailing Address - Country:US
Mailing Address - Phone:818-378-9549
Mailing Address - Fax:
Practice Address - Street 1:777 N JEFFERSON ST STE 408
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-3875
Practice Address - Country:US
Practice Address - Phone:818-378-9549
Practice Address - Fax:877-712-5707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI13078OtherLICENSE NUMBER