| Icor LLC | |
|
5926 N Santa Monica Blvd Milwaukee WI 53217-4618 | |
| (773) 715-8034 | |
| Not Available |
| Full Name | Icor LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 5926 N Santa Monica Blvd, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Ludmil Lazarov (OWNER) |
| Authorized Official Contact | 7737158034 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Icor LLC 5926 N Santa Monica Blvd Milwaukee WI 53217-4618 | Icor LLC 5926 N Santa Monica Blvd Milwaukee WI 53217-4618 Ph: (773) 715-8034 |
| NPI Number | 1649863986 |
|---|---|
| Provider Enumeration Date | 02/18/2021 |
| Last Update Date | 04/15/2021 |
| Certification Date | 04/15/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649863986 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Secondary |
| 207R00000X | Internal Medicine | () | Primary |
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