Organization
MIDWEST DIALYSIS CENTER, INC
Active
Organization
MIDWEST DIALYSIS CENTER, INC
Active
Other names
Midwest Dialysis Center, Inc-27th Street Branch
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID A KURZ (V.P. OPERATIONS)
(414) 762-2020
Entity
Organization
Contact information
Practice address
3120 S 27TH ST, MILWAUKEE, WI 53215-4338
(414) 672-1006
(414) 672-1016
Mailing address
335 EAST MAHN COURT, OAK CREEK, WI 53154
(414) 762-2020
(414) 762-2024
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
42063100
MEDICAID PROVIDER NUMBER
WI
05
—
42063100
—
WI
01
—
522573
MEDICARE PROVIDER NUMBER
WI
Enumeration date
04/03/2007
Last updated
10/27/2011
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