Organization
MILWAUKEE HEALTH SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TITO IZARD (PRESIDENT CEO)
(414) 267-2021
Entity
Organization
Contact information
Practice address
2555 N DR MARTIN LUTHER KING DR, MILWAUKEE, WI 53212-2709
(414) 267-2021
(414) 372-7420
Mailing address
2555 N DR MARTIN LUTHER KING JR DR, MILWAUKEE, WI 53212-2709
(414) 267-2021
(414) 372-7420
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32831100
—
WI
05
—
32958200
—
WI
05
—
33724600
—
WI
05
—
33743200
—
WI
05
—
33780500
—
WI
05
—
33782900
—
WI
05
—
42183000
—
WI
05
—
43086700
—
WI
05
—
44066400
—
WI
01
—
521804
MEDICAID UGS#
WI
01
—
521829
MEDICARE UGS#
WI
Enumeration date
02/01/2007
Last updated
06/18/2021
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