Organization
SUBDOC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KARINA CHELSKY (ADMINISTRATOR)
(414) 467-8884
Entity
Organization
Contact information
Practice address
7275 N PORT WASHINGTON RD APT 314, MILWAUKEE, WI 53217-3337
(414) 467-8884
(414) 435-3126
Mailing address
7275 N PORT WASHINGTON RD APT 314, MILWAUKEE, WI 53217-3337
(414) 467-8884
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
—
—
207Q00000X
Family Medicine Physician
—
—
261Q00000X
Clinic/Center
Primary
—
—
261QR1100X
Research Clinic/Center
—
—
Other
Enumeration date
11/29/2018
Last updated
05/25/2022
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