| Legal Business Name | |
|
7114 W. Capitol Drive Milwaukee WI 53216 | |
| (414) 616-8901 | |
| (414) 616-8906 |
| Full Name | Legal Business Name |
|---|---|
| Speciality | Family Medicine |
| Location | 7114 W. Capitol Drive, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Cha Lee (DOCTOR OWNER) |
| Authorized Official Contact | 4146168901 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Legal Business Name 7114 W Capitol Dr Milwaukee WI 53216-2052 Ph: (414) 616-8901 | Legal Business Name 7114 W. Capitol Drive Milwaukee WI 53216 Ph: (414) 616-8901 |
| NPI Number | 1902905839 |
|---|---|
| Provider Enumeration Date | 09/21/2006 |
| Last Update Date | 10/04/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902905839 | NPI | - | NPPES |
| 34066500 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 42508020 (Wisconsin) | Primary |
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