# SUBDOC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477023729
- **Authorized official:** KARINA CHELSKY (ADMINISTRATOR)
- **Authorized official phone:** (414) 467-8884

## Contact information

- **Practice address:** 7275 N PORT WASHINGTON RD APT 314, MILWAUKEE, WI 53217-3337
- **Practice address phone:** (414) 467-8884
- **Practice address fax:** (414) 435-3126
- **Mailing address:** 7275 N PORT WASHINGTON RD APT 314, MILWAUKEE, WI 53217-3337
- **Mailing address phone:** (414) 467-8884

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 175T00000X | Peer Specialist | — | NULL | — |
| 175T00000X | Peer Specialist | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 261Q00000X | Clinic/Center | — | NULL | Yes |
| 261QR1100X | Research Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 11/29/2018
- **Last updated:** 05/25/2022