Organization
VIVA ADVANCED HEALTHCARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MANUEL D THOMAS MD (PRESIDENT/OWNER)
(414) 551-2911
Entity
Organization
Contact information
Practice address
1107 W OKLAHOMA AVE, MILWAUKEE, WI 53215-4617
(414) 551-2911
(414) 384-3404
Mailing address
PO BOX 639, THIENSVILLE, WI 53092-0639
(414) 247-9005
(414) 247-9004
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
47171
WI
208000000X
Pediatrics Physician
47171
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790870558
—
WI
Enumeration date
07/14/2016
Last updated
07/15/2016
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