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Organization

WESTSIDE HEALTHCARE ASSOCIATION INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. TANGELA M POOLE (CHIEF FINANCIAL OFFICER)
(414) 934-7582
Entity
Organization

Contact information

Practice address
3522 W LISBON AVE, MILWAUKEE, WI 53208-1953
(414) 935-8000
(414) 755-0058
Mailing address
3522 W LISBON AVE, MILWAUKEE, WI 53208-1953
(414) 935-8000
(414) 755-0058

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
4109
WI
207Q00000X
Family Medicine Physician
Primary
49433
WI
363A00000X
Physician Assistant
2023
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
32957400
WI
Enumeration date
06/13/2008
Last updated
06/13/2008
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