Provider Demographics
NPI:1982459582
Name:SOLIDARITUS HEALTH WISCONSIN SC
Entity Type:Organization
Organization Name:SOLIDARITUS HEALTH WISCONSIN SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:LAKEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-304-6764
Mailing Address - Street 1:1025 CONNECTICUT AVE NW STE 907
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-5434
Mailing Address - Country:US
Mailing Address - Phone:888-491-2951
Mailing Address - Fax:
Practice Address - Street 1:W183S8750 RACINE AVE # 3
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-8067
Practice Address - Country:US
Practice Address - Phone:262-971-1798
Practice Address - Fax:262-679-1378
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOLIDARITUS HEALTH WISCONSIN SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty