Organization
MIDWEST DIALYSIS CENTER, INC.
Active
Other names
Midwest Dialysis Center-Appleton Ave Branch
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY V WARREN MD (OWNER)
(414) 762-2020
Entity
Organization
Contact information
Practice address
7793 W APPLETON AVE, MILWAUKEE, WI 53222-2009
(414) 762-2020
(414) 762-2024
Mailing address
7793 W APPLETON AVE, MILWAUKEE, WI 53222-2009
(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
—
42062700
MEDICAID PROVIDER NUMBER
WI
05
—
42062700
—
WI
01
—
522571
MEDICARE PROVIDER NUMBER
WI
Enumeration date
10/17/2006
Last updated
10/27/2011
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