Provider Demographics
NPI:1386968428
Name:MILWAUKEE NEPHROLOGY CARE INC
Entity type:Organization
Organization Name:MILWAUKEE NEPHROLOGY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOLZMACHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-202-1724
Mailing Address - Street 1:19050 BLUE RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-5103
Mailing Address - Country:US
Mailing Address - Phone:414-202-1724
Mailing Address - Fax:888-315-3739
Practice Address - Street 1:19050 BLUE RIDGE CT
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-5103
Practice Address - Country:US
Practice Address - Phone:414-202-1724
Practice Address - Fax:888-315-3739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QH0100X
WI42642-020261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34749000Medicaid
WII10667Medicare UPIN