Provider Demographics
NPI:1063961662
Name:ENERQI, INC
Entity type:Organization
Organization Name:ENERQI, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:PROF
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, MSOM
Authorized Official - Phone:414-209-4228
Mailing Address - Street 1:10827 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-1127
Mailing Address - Country:US
Mailing Address - Phone:414-209-4228
Mailing Address - Fax:
Practice Address - Street 1:10827 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-1127
Practice Address - Country:US
Practice Address - Phone:414-209-4228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-25
Last Update Date:2016-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI913-55261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center