Organization
NOVA MEDICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MAIYIA VANG (PRESIDENT)
(414) 643-8815
Entity
Organization
Contact information
Practice address
3501 W GREENFIELD AVE, MILWAUKEE, WI 53215-1445
(414) 643-8815
(414) 643-8816
Mailing address
3501 W GREENFIELD AVE, MILWAUKEE, WI 53215-1445
(414) 643-8815
(414) 643-8816
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
14421-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21282200
—
WI
Enumeration date
03/18/2008
Last updated
11/03/2016
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