Provider Demographics
NPI:1588739155
Name:MILWAUKEE PSYCHIATRIC PHYSICIANS CHARTERED
Entity type:Organization
Organization Name:MILWAUKEE PSYCHIATRIC PHYSICIANS CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-439-5500
Mailing Address - Street 1:12760 W NORTH AVE, BLDG A
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005
Mailing Address - Country:US
Mailing Address - Phone:262-439-5500
Mailing Address - Fax:866-439-5221
Practice Address - Street 1:12760 W NORTH AVE BLDG A
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4628
Practice Address - Country:US
Practice Address - Phone:262-439-5500
Practice Address - Fax:866-439-5221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty