| Nova Medical Center Llc | |
|
3501 W Greenfield Ave Milwaukee WI 53215-1445 | |
| (414) 643-8815 | |
| (414) 643-8816 |
| Full Name | Nova Medical Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3501 W Greenfield Ave, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Maiyia Vang (PRESIDENT) |
| Authorized Official Contact | 4146438815 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nova Medical Center Llc 3501 W Greenfield Ave Milwaukee WI 53215-1445 Ph: (414) 643-8815 | Nova Medical Center Llc 3501 W Greenfield Ave Milwaukee WI 53215-1445 Ph: (414) 643-8815 |
| NPI Number | 1336310374 |
|---|---|
| Provider Enumeration Date | 03/18/2008 |
| Last Update Date | 11/03/2016 |
| Medicare PECOS PAC ID | 7810948007 |
|---|---|
| Medicare Enrollment ID | O20050204000368 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336310374 | NPI | - | NPPES |
| 21282200 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 14421-020 (Wisconsin) | Primary |
| Provider Name | Sergio C Casaclang |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871502906 PECOS PAC ID: 2961554845 Enrollment ID: I20090723000749 |
| Provider Name | Biji B Joseph |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073834735 PECOS PAC ID: 1254596109 Enrollment ID: I20120627000807 |
| Provider Name | Angelia Felton-wilks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669720041 PECOS PAC ID: 5395048268 Enrollment ID: I20160127000641 |
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