Organization
MILWAUKEE HEALTH SERVICES INC
Active
Other names
Martin Luther King Heritage Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TITO L IZARD M.D. (PRESIDENT/CHIEF EXECUTIVE OFFICER)
(414) 267-2022
Entity
Organization
Contact information
Practice address
2555 N MARTIN LUTHER KING DR, MILWAUKEE, WI 53212-2709
(414) 267-2022
(414) 372-7420
Mailing address
2555 N MARTIN LUTHER KING DR, MILWAUKEE, WI 53212-2709
(414) 267-2022
(414) 372-7420
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
102001-30
WI
251B00000X
Case Management Agency
72014-30
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000002690
MEDICARE PTAN
WI
Enumeration date
07/21/2014
Last updated
07/21/2014
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