Provider Demographics
NPI:1285892331
Name:COUNTY OF MILWAUKEE
Entity type:Organization
Organization Name:COUNTY OF MILWAUKEE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-257-5205
Mailing Address - Street 1:9201 W WATERTOWN PLANK RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3558
Mailing Address - Country:US
Mailing Address - Phone:414-257-6995
Mailing Address - Fax:
Practice Address - Street 1:9201 W WATERTOWN PLANK RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3558
Practice Address - Country:US
Practice Address - Phone:414-257-6995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI00812OtherMEDICARE ID-TYPE UNSPECIFIED
WI43420800Medicaid
WI43420900OtherMEDICAID PERFORMING PROVIDER ID