Organization
MILWAUKEE HEALTH SERVICES INC
Active
Other names
Isaac Coggs Heritage Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TITO L IZARD M.D. (PRESIDENT CEO)
(414) 267-2021
Entity
Organization
Contact information
Practice address
8200 W SILVER SPRING DR, ATTENTION: TITO IZARD, M.D., MILWAUKEE, WI 53218-2552
(414) 267-2021
(414) 372-7420
Mailing address
2555 N MARTIN LUTHER KING DR, MILWAUKEE, WI 53212-2709
(414) 267-2021
(414) 372-7420
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
N/A
—
333600000X
Pharmacy
Primary
8664-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32958200
—
WI
05
—
36229500
—
WI
Enumeration date
06/01/2006
Last updated
04/05/2016
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