Provider Demographics
NPI:1063953529
Name:LICE CLINICS OF AMERICA MILWAUKEE
Entity type:Organization
Organization Name:LICE CLINICS OF AMERICA MILWAUKEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORSHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-806-0477
Mailing Address - Street 1:13435 WATERTOWN PLANK RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-2201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13435 WATERTOWN PLANK RD
Practice Address - Street 2:SUITE 1
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2201
Practice Address - Country:US
Practice Address - Phone:262-806-0477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty