Provider Demographics
NPI:1386774958
Name:CITY OF MILWAUKEE HEALTH DEPARTMENT
Entity type:Organization
Organization Name:CITY OF MILWAUKEE HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMISSIONER OF HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:BEVAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:414-286-3521
Mailing Address - Street 1:841 N BROADWAY FL 3
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3639
Mailing Address - Country:US
Mailing Address - Phone:414-286-3521
Mailing Address - Fax:414-286-5990
Practice Address - Street 1:841 N BROADWAY FL 3
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-3639
Practice Address - Country:US
Practice Address - Phone:414-286-3521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF MILWAUKEE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-06
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251B00000X, 261QH0100X, 261QP0905X, 261QP2300X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No251B00000XAgenciesCase Management
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41855700Medicaid
WI000081554Medicare ID - Type UnspecifiedMHD LAB
WI41855700Medicaid